Evaluating associations between trauma-related characteristics and functional recovery in individuals with spinal cord injury

Abstract

Objective

To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during inpatient rehabilitation for individuals with spinal cord injury (SCI). The associations were evaluated by linking individuals’ records between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases.

Design

Retrospective cohort analysis.

Setting

Two SCI Model Centers in Pennsylvania, United States.

Methods

We used a record linkage toolkit in Python to link 735 individuals with traumatic SCI between the databases. The percentage for true-match and error were 92.0% and 0.1%, respectively. The functional recovery during inpatient rehabilitation was determined in 604 individuals with SCI by ordinary least squares regression (OLS) and gradient boosting regression (GBR) analyses.

Results

The OLS and GBR analyses indicated older age, greater impairment (SCI level combined with American Spinal Injury Association impairment scale), presence of diabetes mellitus, pulmonary complications during acute care, and longer length of stay at an inpatient rehabilitation facility were associated with lower functional recovery (OLS R²= 0.56 and GBR R²= 0.58).

Conclusions

Trauma and acute care variables in addition to patient characteristics were associated with functional recovery during inpatient rehabilitation in individuals with SCI. Further investigation is needed to understand the role of diabetes mellitus and pulmonary complications, which have not been previously associated with functional recovery in individuals with SCI.

Keywords:

• Traumatic spinal cord injury
• Functional status
• Acute care
• Inpatient rehabilitation
• Linking

Acknowledgements

Research reported in this publication was supported by the National Center for Medical Rehabilitation Research (NCMRR), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award number 1R03HD101064. The authors would like to thank the Pennsylvania Trauma Systems Foundation and the Trauma and Surgical Critical Care at Temple University Hospital for their support in obtaining data from the PTOS database. The authors would also like to thank the Regional Spinal Cord Injury Center of Delaware Valley, the University of Pittsburgh Model Center on Spinal Cord Injury, and the National Spinal Cord Injury Statistical Center for their support in obtaining data from the SCIMS database.

Disclaimer statements

Contributors None.

Funding This work was supported by the National Institutes of Health (NIH) – National Center for Medical Rehabilitation Research at the Eunice K. Shriver National Institute of Child Health and Human Development (NICHD) – under Grant number R03HD101064.

Declaration of interest The content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD or the National Institutes of Health (NIH). The PTOS data was provided by the Pennsylvania Trauma Systems Foundation, Mechanicsburg, PA, USA. The foundation specifically disclaims responsibility for any analyses, interpretations, or conclusions.

Conflicts of interest Authors have no conflict of interests to declare.