Time-related Complications in Patients with Traumatic Spinal Cord Injury according to the AIS Impairment Scale Grade: A Retrospective Review

Abstract

Purpose: The aim of this study was to analyze time-dependent complications in patients with traumatic spinal cord injury (SCI) as a function of their initial neurological status determined by the ASIA Impairment Scale (AIS) grade. Methods: Consecutive patients with SCI who visited the emergency department at Asan Medical Center from 2005 to 2019 were included, and their electronic medical records were analyzed according to four time periods from initial visit to hospital discharge. Time-dependent SCI-related complications, including medical, urinary, musculoskeletal, and neurological complications and pain, were analyzed as well as the association between SCI complications and AIS grade. In-hospital recovery from neurological damage and long-term outcomes were also evaluated. Results: Of the 632 SCI patients who visited the emergency department during the study period, 110 patients were included in the study. The complication rates in patients initially assessed as AIS grades A, B, C, D, and E were 53.6%, 16.4%, 14.6%, 13.6%, and 1.8%, respectively. The most common complications after SCI were UTIs (n=37; 33.6%), pressure ulcers (n=36; 32.7%), neuropathic pain (n=34; 30.9%), and pneumonia (n=33; 30.0%). Patients with a poor neurological status (AIS grade A) had more medical complications and lower neurological resilience than did those with better neurological status (AIS grades B-E). Conclusion: Post-SCI complications differed by time after SCI and neurological status. Nurses should be aware that complications can occur at any time in patients with traumatic SCI. Patients with poorer AIS grades should be particularly closely observed and receive preventive care for complications.