Journal of Rehabilitation Medicine 51-7 | Page 44

J Rehabil Med 2019; 51: 513–517 ORIGINAL REPORT SECONDARY MEDICAL COMPLICATIONS AFTER TRAUMATIC SPINAL CORD INJURY IN STOCKHOLM, SWEDEN: TOWARDS DEVELOPING PREVENTION STRATEGIES Kerstin WAHMAN, PhD 1,2 , Lena NILSSON WIKMAR, PhD 1,3 , Giorgi CHLAIDZE, Bsc 1 and Conran JOSEPH, PhD 1,4 From the 1 Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, 2 Rehab Station Stockholm, Research and Development Unit, 3 Academic Primary Healthcare Centre, Stockholm County Council, Stockholm, Sweden and 4 University of the Western Cape, Physiotherapy Department, South Africa Objectives: (i) To determine the prevalence of se- condary complications after traumatic spinal cord injury during acute care and rehabilitation; (ii) to in- vestigate whether associations exist between level and completeness of injury and the development of common complications; and (iii) to assess whether associations exist between secondary complications and return-to-work 1 year after injury. Design and participants: A prospective, population- based study, including all newly-injured persons with traumatic spinal cord injury for an 18-month period. Methods: The International Spinal Cord Injury Core Data Set was used to capture injury characteristics, as well as associated injuries and neurological seve- rity. All secondary medical complications (e.g. pres- sure injuries, pulmonary embolism, pneumonia, uri- nary tract infection) were screened for during acute care and rehabilitation. Inferential statistics were carried out. Results: Out of the 45 persons undergoing acute care, the 3 most common complications were uri- nary tract infections (47%), pneumonia (22%) and neuropathic pain (18%). Of the 31 persons who re- ceived rehabilitation, the most common complica- tions were urinary tract infections (42%), neuropa- thic pain (42%), and spasticity (35%). A significant association was found between injury level and de- velopment of neuropathic pain during rehabilitation. Conclusion: Although a specialized system for spi- nal cord injury management is available in Sweden, secondary complications are still common. These findings could be used to inform the development of strategies for prevention of secondary complica- tions. Key words: traumatic spinal cord injury; secondary medical complications; acute care; rehabilitation; return-to-work. Accepted May 16, 2019: Epub ahead of print May 28, 2019 J Rehabil Med 2019; 51: 513–517 Correspondence address: Conran Joseph, Karolinska Institutet, De- partment of Neurobiology, Care Sciences and Society (NVS), Division of Physiotherapy, 23100, SE-141 83 Huddinge, Sweden. E-mail: con- [email protected]; [email protected] S pinal cord injuries (SCI) typically result in sensory, motor, and autonomic deficits below the level of LAY ABSTRACT Development of secondary complications is common af- ter acute traumatic spinal cord injury. The presence of secondary complications may influence one’s livelihood and quality of life. This study examined the nature and number of secondary complications among persons with acute traumatic spinal cord injury throughout the care pathway in Sweden. All patients with a traumatic spi- nal cord injury were observed for 18 months and follo- wed through acute, inpatient rehabilitation, up until 12 months after injury. Certain secondary complications, such as urinary tract infections, pneumonia, neuropa- thic pain, were common during acute care and rehabi- litation. Subjects with tetraplegia reported neuropathic pain more than those with paraplegia during both pha- ses of care. In conclusion, complications occur despite the specialized system of care for persons with trauma- tic spinal cord injury in Sweden. This information should be used to develop and implement appropriate preven- tion programmes. the lesion (1). These hallmark impairments provide conditions for the development of secondary medical complications, which have been found to influence sur- vival status (2), neurological and functional recovery (3), and health-related quality of life (3). Furthermore, the development of secondary medical complications has been associated with extended length of hospital stays, impacting hospital efficiency, an important target since severe reductions in the availability of scarce resources, such as specialist services, are experienced globally (4, 5). Specialized care is available for people with SCI, including state-of-the-art emergency care at the scene of injury, efficient and safe transfer to a specialized trauma unit, availability of all diagnostic equipment, skilled and experienced multidisciplinary teams, as well as the availability of acute (primary) and active rehabilitation (6). Perhaps, the single most important outcome of the specialized approach followed in Sweden has been its effect on survival, where a zero percentage mortality was found for a 1-year period in a population-based cohort (7). However, research reports from 20 and 10 years ago, respectively, found that selected secondary medical complications, such as pressure injuries, urinary tract infections (UTIs), This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2568