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
ARTICLE HIGHLIGHTS
Research background

Acute spinal cord injury is a common type of severe trauma in the emergency department, and can have catastrophic consequences in patients.

Research motivation

To describe the present treatment of acute traumatic spinal cord injury (ATSCI) and provide important suggestions for future clinical practice.

Research objectives

The objective of our study was to provide a systematic and basic theoretical basis for improving the treatment of ATSCI.

Research methods

This retrospective study enrolled patients with ATSCI from 2012 to 2017, and recorded their demographic and clinical characteristics. Patients were followed-up at one year after discharge. The American Spinal Injury Association (ASIA) score was re-calculated, and the recovery of neurological function was evaluated according to ASIA guidelines.

Research results

A total of 440 ATSCI patients were enrolled in our study, and 304 of these patients were included in the final analysis. The results of the analysis indicated that ATSCI was more likely to occur in young and middle-aged males and the cervical spinal cord was the most commonly injured site. A statistically significant difference in prognosis was observed between patients who underwent surgery within 72 h and those who underwent surgery after 72 h (P < 0.05). A significant difference between the Steroid group and the Non-Steroid group in terms of outcome was noticed in the ASIA grade A and B subgroups (P < 0.05). In addition, patients with pneumonia had a worse prognosis when compared with those without pneumonia (P < 0.05).

Research conclusions

Our study described the current situation in ATSCI patients with long-term follow-up and the findings in our study have important implications for future clinical practice. Surgery within 72 h resulted in a better prognosis. This study found that there was no significant difference in hospitalization time and prognosis between the Steroid group and the Non-Steroid group. However, 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 consequences of ATSCI are disastrous and there is still a lack of consensus on treatment. We need to further improve the treatment strategy in order to obtain more reliable functional improvement.

Research perspectives

This research area requires randomized multicenter studies with a larger sample size to provide more clinical evidence for the optimal management strategy in ATSCI patients to achieve a better prognosis.