Abstract
Study design
Cohort study.
Objectives
It is widely accepted that the prediction of long-term neurologic outcome after traumatic spinal cord injury (SCI) can be done more accurately with neurological examinations conducted days to weeks post injury. However, modern clinical trials of neuroprotective interventions often require patients be examined and enrolled within hours. Our objective was to determine whether variability in timing of neurological examinations within 48 h after SCI is associated with differences in observations of follow-up neurologic recovery.
Setting
Level I trauma hospital.
Methods
An observational analysis testing for differences in AIS conversion rates and changes in total motor scores by neurological examination timing, controlling for potential confounders with multivariate stepwise regression.
Results
We included 85 patients, whose mean times from injury to baseline and follow-up examinations were 11.8 h (SD 9.8) and 208.2 days (SD 75.2), respectively. AIS conversion by 1+ grade was significantly more likely in patients examined at ≤4 h in comparison with later examination (78% versus 47%, RR = 1.66, p = 0.04), even after controlling for timing of surgery, age, and sex (OR 5.0, 95% CI 1.1–10, p = 0.04). We failed to identify any statistically significant associations for total motor score recovery in unadjusted or adjusted analyses.
Conclusions
AIS grade conversion was significantly more likely in those examined ≤4 h of injury; the effect of timing on motor scores remains uncertain. Variability in neurological examination timing within hours after acute traumatic SCI may influence observations of long-term neurological recovery, which could introduce bias or lead to errors in interpretation of studies of therapeutic interventions.
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Data availability
The raw data analyzed in this study are not publicly available due to stipulations about their use with the participating hospital facility and the participants themselves, but an application for data access can be made to the Rick Hansen Institute’s Data Steward, via the corresponding author, and data may be available on reasonable request with permission from the participating hospital facility’s principal investigator.
Change history
09 January 2020
A Correction to this paper has been published: https://doi.org/10.1038/s41393-020-0413-y
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Acknowledgements
We would like to thank the Vancouver Spine Research Program team at Vancouver General Hospital for their help in data collection. BKK is the Canada Research Chair in Spinal Cord Injury and Dvorak Chair in Spine Trauma.
Funding
The Rick Hansen Spinal Cord Injury Registry and this work are supported by funding from the Rick Hansen Institute, Health Canada and Western Economic Diversification Canada.
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BKK, NE, NF, VKN, and BS designed the study. TA, RC-M, MD, ND, NE, CF, BKK, VKN, SP, BS, JS, and ZW assisted with the data acquisition. NE, NF, and BS performed the analysis of the data. NE led paper preparation and all authors contributed to the interpretation of the data and helped to write, review and edit the paper.
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All local research ethics board approvals were obtained prior to recruitment of participants. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
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Evaniew, N., Sharifi, B., Waheed, Z. et al. The influence of neurological examination timing within hours after acute traumatic spinal cord injuries: an observational study. Spinal Cord 58, 247–254 (2020). https://doi.org/10.1038/s41393-019-0359-0
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DOI: https://doi.org/10.1038/s41393-019-0359-0
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