Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury.

Importance: Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).

Objective: To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.

Design, Setting, And Participants: Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL).

Bladder Management With Chronic Indwelling Catheter is Associated with Elevated Mortality in Patients with Spinal Cord Injury.

Objective: To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database.

Methods: Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened.

Demographic and Health Profiles of People Living With Traumatic Spinal Cord Injury in the United States During 2015-2019: Findings from the Spinal Cord Injury Model Systems Database.

Objective: To estimate the population profile of people living with traumatic spinal cord injury (TSCI) to help evaluate health care needs of this aging population.

Design: Cross-sectional study.

Setting: SCI Model Systems (SCIMS) centers in the United States.

Cause of Death Trends Among Persons With Spinal Cord Injury in the United States: 1960-2017.

Objective: To identify trends in causes of death after spinal cord injury (SCI) that could enhance understanding of why life expectancy after SCI has not improved in the last 3 decades.

Design: Cohort study.

Setting: Twenty-nine SCI Model Systems and 3 Shriners Hospitals.

Mortality Beyond the First Year After Spinal Cord Injury: Does Body Mass Index Matter?

Objective: To examine the association between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and mortality after the first year post spinal cord injury (SCI) overall and across demographic and injury characteristics.

Design: Cohort study.

Setting: Sixteen Spinal Cord Injury Model Systems (SCIMS) centers.

Colorectal cancer mortality after spinal cord injury.

Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the US. There is paucity of data regarding CRC and the spinal cord injury (SCI) community. Persons with SCI have suboptimal rates of colonoscopies and face extensive barriers to care.

The impact of body mass index on one-year mortality after spinal cord injury.

Evaluate the association between body mass index (BMI, kg/m) and one-year mortality among people who survived the first 90 days after spinal cord injury (SCI). Cohort study. Eighteen SCI Model Systems centers throughout the United States.

The Burden of Traumatic Spinal Cord Injury in the United States: Disability-Adjusted Life Years.

Objective: To quantify the burden of traumatic spinal cord injury (SCI) as defined by nonfatal health loss and premature mortality among a large sample of participants over a 44-year period, and estimate the national burden of SCI in the United States for the year 2010.

Design: Longitudinal.

Setting: National SCI Model Systems and Shriners Hospitals.

Racial Differences in Data Quality and Completeness: Spinal Cord Injury Model Systems' Experiences.

Among people with spinal cord injury (SCI), minorities experience a disproportionately higher burden of diseases. Knowledge of data quality by race/ethnicity will help better design racial health disparity research and understand potential errors/biases. To investigate racial/ethnic differences in response completeness in a longitudinal SCI database.

Comparison of statistical methods for calculating life expectancy after spinal cord injury.

Study Design: Retrospective observational.

Objectives: To compare results of several different methods for calculating life expectancy in the same sample of people with spinal cord injury (SCI), and critically assess their advantages and disadvantages.

Setting: Two spinal centres in Great Britain.

Spinal cord injury-induced immunodeficiency is mediated by a sympathetic-neuroendocrine adrenal reflex.

Acute spinal cord injury (SCI) causes systemic immunosuppression and life-threatening infections, thought to result from noradrenergic overactivation and excess glucocorticoid release via hypothalamus-pituitary-adrenal axis stimulation. Instead of consecutive hypothalamus-pituitary-adrenal axis activation, we report that acute SCI in mice induced suppression of serum norepinephrine and concomitant increase in cortisol, despite suppressed adrenocorticotropic hormone, indicating primary (adrenal) hypercortisolism. This neurogenic effect was more pronounced after high-thoracic level (Th1) SCI disconnecting adrenal gland innervation, compared with low-thoracic level (Th9) SCI.

Long-term functional outcome in patients with acquired infections after acute spinal cord injury.

Objective: To investigate whether prevalent hospital-acquired pneumonia and wound infection affect the clinical long-term outcome after acute traumatic spinal cord injury (SCI).

Methods: This was a longitudinal cohort study within the prospective multicenter National Spinal Cord Injury Database (Birmingham, Alabama). We screened datasets of 3,834 patients enrolled in 20 trial centers from 1995 to 2005 followed up until 2016.

Spinal Cord Injury Model Systems: Review of Program and National Database From 1970 to 2015.

The Spinal Cord Injury Model Systems (SCIMS) centers have provided continuous, comprehensive multidisciplinary care for persons with spinal cord injury (SCI) in the United States since their inception in 1970. In addition, the research conducted and the analysis of data collected at these centers facilitate advances in the care and the overall quality of life for people with SCI. Over the past 45 years, the SCIMS program and National Spinal Cord Injury Database (NSCID) have undergone major revisions, which must be recognized in the planning, conduct, and interpretation of SCIMS research to prevent misinterpretation of findings.

Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury.

Objective: To investigate the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI).

Design: Retrospective analysis of a prospectively created cohort.

Setting: Spinal Cord Injury Model Systems facilities.

Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States, 1972-2014.

Objective: To document trends in the demographic and injury profile of new spinal cord injury (SCI) over time.

Design: Cross-sectional analysis of longitudinal data by injury years (1972-1979, 1980-1989, 1990-1999, 2000-2009, 2010-2014).

Setting: Twenty-eight Spinal Cord Injury Model Systems centers throughout the United States.

Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level.

Pneumonia is the leading cause of death after acute spinal cord injury and is associated with poor neurological outcome. In contrast to the current understanding, attributing enhanced infection susceptibility solely to the patient's environment and motor dysfunction, we investigate whether a secondary functional neurogenic immune deficiency (spinal cord injury-induced immune deficiency syndrome, SCI-IDS) may account for the enhanced infection susceptibility. We applied a clinically relevant model of experimental induced pneumonia to investigate whether the systemic SCI-IDS is functional sufficient to cause pneumonia dependent on spinal cord injury lesion level and investigated whether findings are mirrored in a large prospective cohort study after human spinal cord injury.

Aging and Spinal Cord Injury: External Causes of Injury and Implications for Prevention.

Background: Despite a consistent trend toward older age at time of spinal cord injury (SCI), little is known about the external causes of SCI in the elderly.

Objective: To examine environmental circumstances, documented by International Classification of Diseases, 10th Revision, Clinical Modification codes, at time of SCI among older adults.

Methods: Data on individuals injured in 2005 or later were retrieved from the National SCI Database.

Fall-induced spinal cord injury: External causes and implications for prevention.

Objective: To document the demographic and clinical profile of persons who sustained spinal cord injury (SCI) as a result of accidental falls and to determine the usual circumstances surrounding the fall-induced SCI.

Design: Cohort study.

Setting: 21 SCI Model Systems centers throughout the United States.

Improvements in long-term survival after spinal cord injury?

Objective: To investigate whether there have been improvements in long-term survival after spinal cord injury in recent decades.

Design: Survival analysis using time-varying covariates. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year.

Bladder cancer mortality after spinal cord injury over 4 decades.

Purpose: We estimate bladder cancer mortality in people with spinal cord injury compared to the general population.

Materials And Methods: Data and statistics were retrieved from the National Spinal Cord Injury Statistical Center and the National Center for Health Statistics. The mortality experience of the 45,486 patients with traumatic spinal cord injury treated at a Spinal Cord Injury Model System or Shriners Hospital was compared to the general population using a standardized mortality ratio.

Mobility, continence, and life expectancy in persons with Asia Impairment Scale Grade D spinal cord injuries.

Objective: Previous research on the life expectancy of persons with American Spinal Injury Association (ASIA) Impairment Scale Grade D spinal cord injury has considered them as a large homogenous group, making no functional or medical distinctions. This study sought to (1) determine how survival in this group depends on ambulatory function and the extent of bowel or bladder dysfunction, (2) compute life expectancies for various subgroups, and (3) examine whether survival has improved over time.

Design: Data were from 8,206 adults with ASIA Impairment Scale Grade D spinal cord injury in the Spinal Cord Injury Model Systems database who were not ventilator dependent and who survived more than 1 yr after injury.