Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4807-4815
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4807
Factors related to improved American Spinal Injury Association grade of acute traumatic spinal cord injury
Ci Tian, Yang Lv, Shu Li, Dai-Dai Wang, Yi Bai, Fang Zhou, Qing-Bian Ma
Ci Tian, Shu Li, Dai-Dai Wang, Yi Bai, Qing-Bian Ma, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
Yang Lv, Fang Zhou, Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
Author contributions: Tian C designed the research, performed the research and wrote the paper; Ma QB designed the research; Li S reviewed and edited the manuscript; all authors read and approved the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Peking University Third Hospital, China (No. M2020232).
Informed consent statement: Patients were not required to give informed consent for this study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at maqingbain@bjmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Bian Ma, MD, Associate Professor, Chairman, Chief Physician, Department of Emergency Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China. maqingbian@bjmu.edu.cn
Received: June 19, 2020
Peer-review started: June 19, 2020
First decision: August 23, 2020
Revised: August 26, 2020
Accepted: September 11, 2020
Article in press: September 11, 2020
Published online: October 26, 2020
Processing time: 129 Days and 8.1 Hours
Abstract
BACKGROUND

Acute traumatic spinal cord injury (ATSCI) usually results in disability, yet data on contemporary national trends of ATSCI incidence are limited.

AIM

To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord injury.

METHODS

Data from the Peking University Third Hospital Inpatient Sample databases were analyzed. A total of 304 patients with ATSCI were included from 2012 to 2017. The epidemiological data, treatment, complications and clinical outcomes of these patients were reviewed.

RESULTS

Of the 304 patients, 257 (84.5%) were male, and 75% of the patients were 55 years old or younger. 135 patients had improved follow-up American Spinal Injury Association (ASIA) grades (44.4%). Only 14 patients with ASIA grade A improved. A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed (P < 0.05). Surgery within 72 h resulted in better prognosis. The Steroid group and the Non-Steroid group showed a significant difference in outcome among patients with ASIA grades A and B (P < 0.05). Patients with pneumonia had a poorer prognosis than patients without pneumonia (P < 0.05). Surgery within 72 h resulted in better prognosis.

CONCLUSION

This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group, but the patients with severe spinal cord injury (ASIA grades A and B) who underwent surgery combined with steroid therapy had a better prognosis than those who underwent surgery alone. The disastrous consequences of ATSCI and lack of consensus on the management strategy are obvious. Further improvements in treatment planns are needed in order to obtain more reliable functional outcomes.

Keywords: Acute spinal cord injury; Trauma; Surgery; American Spinal Injury Association; Steroids; Prognosis

Core Tip: Our study describes the present treatment of acute traumatic spinal cord injury. This study found that surgery within 72 h resulted in a better prognosis. Patients with American Spinal Injury Association (ASIA) grades A and B had a significantly better prognosis when treated with steroids. The present study demonstrates that patients with severe spinal cord injury (ASIA grades A and B) may benefit from early surgery and steroid administration. These findings have implications for future clinical practice.