Comparing Blunt and Penetrating Trauma in Spinal Cord Injury: Analysis of Long-Term Functional and Neurological Outcomes

Top Spinal Cord Inj Rehabil, 2018 · DOI: 10.1310/sci2402-121 · Published: January 1, 2018

Spinal Cord Injury Trauma Rehabilitation

Simple Explanation

This study looks at the differences between blunt spinal cord injuries (BSCI) and penetrating spinal cord injuries (PSCI). BSCI includes injuries from falls and car accidents, while PSCI includes gunshot and stab wounds. The study uses a large database to compare the characteristics and outcomes of patients with BSCI and PSCI. They looked at factors like injury severity, surgery rates, and how well patients recovered their motor skills and independence a year after the injury. The findings suggest that patients with PSCI tend to have more severe injuries and worse outcomes than those with BSCI. This could be due to differences in the type of injury, treatment approaches, or other factors.

Study Duration

January 1994 to January 2015

Participants

6,378 SCI admissions (5,316 BSCI and 1,062 PSCI)

Evidence Level

Not specified

Key Findings

1
Patients with PSCI were more likely to have complete injuries and less likely to undergo spine surgery.
2
Patients with complete BSCI showed greater AIS improvement at 1 year, while incomplete injuries showed no difference in neurological improvement between groups.
3
Patients with PSCI demonstrated worse functional outcomes at 1 year.

Research Summary

This study compared baseline characteristics, neurological and functional outcomes for patients with blunt spinal cord injury (BSCI) and penetrating spinal cord injury (PSCI) using the Spinal Cord Injury Model Systems database from 1994 to 2015. The study found that patients with PSCI compared to those with BSCI were more likely to present with complete injuries and were less likely to undergo spine surgery. Patients with complete BSCI showed greater AIS improvement at 1 year, and incomplete injuries showed no difference in neurological improvement between groups. Overall, patients with PSCI demonstrated worse functional outcomes at 1 year.

Practical Implications

Tailored Treatment Strategies

The findings suggest a need for tailored treatment and rehabilitation strategies that address the specific needs of patients with PSCI.

Surgical Considerations

The lower surgery rates in PSCI patients warrant further investigation into the optimal surgical management of these injuries.

Prognosis Awareness

Clinicians should be aware of the potentially poorer outcomes in PSCI patients to manage expectations and provide appropriate support.

Study Limitations

1
The study results are limited by selection bias in those patients who were admitted to an SCIMS institution and in those who underwent treatment and rehabilitation, and they may not be generalizable to a population outside the SCIMS.
2
Patients with BSCI represent a more heterogeneous group than patients with PSCI and include a wider age range and high- and low-speed injury mechanisms such as falls or motor vehicle accidents, which may be associated with any differences in outcomes.
3
The majority of 1-year follow-up interviews in the SCIMS database are conducted via telephone without in-person clinical assessment, and so about two-thirds of AIS scores were missing at 1-year follow-up.

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