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Study design:Retrospective chart analysis.Objectives:To investigate the use of the International Autonomic Standards (IAS, 2009 edition) for classification of remaining autonomic function following spinal cord injury (SCI) over a 1-year period in a rehabilitation center, to determine clinical adherence to use of the IAS, and to examine the most common autonomic dysfunctions, as determined by using the IAS.Setting:Tertiary rehabilitation hospital.Methods:A retrospective study was conducted on the use of the IAS at admission and discharge over a 1-year period on patients admitted to an in-patient SCI unit in a tertiary rehabilitation center. We examined the consistency of the form completion, as well as the completion of separate components of the forms. Finally, we examined the prevalence of each autonomic impairment.Results:A total of 70 patients were admitted to the unit. The clinical adherence to the IAS was lower than the International Standards for Neurological Classification of SCI (ISNCSCI) at both admission (63% and 93%, respectively) and discharge (39% and 78%, respectively). Blood pressure dysfunction was most common among the general autonomic function disorders. However, urinary, bowel and sexual dysfunctions were present in almost all individuals with acute SCI.Conclusion:The IAS is in the initial stages of being incorporated into routine admission and discharge clinical examinations of individuals with SCI. The current results suggest that the clinical adherence to the IAS is low; however, it is expected that increased education, experience, and accumulating evidence for the IAS will improve its use. [ABSTRACT FROM AUTHOR]

Study design:Test-retest analysis.Objectives:To determine the intra- and inter-rater reliability of the Spine Adverse Events Severity System for Spinal Cord Injury (SAVES-SCI) in patients with traumatic SCI.Setting:Quaternary care spine program in Vancouver, Canada.Methods:Ten hypothetical patient cases were developed. The cases were completed by 10 raters (seven physicians, one nurse, one physiotherapist and one researcher) who were asked to identify and grade the severity of adverse events using SAVES-SCI twice with 1-week interval. Intra- and inter-rater reliability were calculated using kappa statistics and intraclass correlation coefficients (ICC).Results:Intra-rater reliability for both identifying and grading AEs were high with all AEs (kappa greater than 0.6) except for bone implant, diathermy burn, massive blood loss, myocardial infarction, neurological deterioration, pressure ulcer, return to operating room and tracheostomy requirment. The inter-rater reliability measured with ICC were all above 0.6 for identifying and grading intraoperative, pre and postoperative AEs and consequences of SCI.Conclusions:The SAVES-SCI demonstrated acceptable intra-and inter-rater reliability for a majority of the AEs. Further clarification and definition of some of the AEs as well as provision of sample training cases for clincians would assist in reducing measurement errors. The SAVES-SCI is a useful tool to assess and capture AEs in patients with acute traumatic SCI.Sponsorship:Funded by Rick Hansen Institute and Health Canada. [ABSTRACT FROM AUTHOR]

Study Design:Observational cohort comparison.Objectives:To compare the previously validated Spine Adverse Events Severity system (SAVES) with International Classification of Diseases, Tenth Revision codes (ICD-10) codes for identifying adverse events (AEs) in patients with traumatic spinal cord injury (TSCI).Setting:Quaternary Care Spine Program.Methods:Patients discharged between 2006 and 2010 were identified from our prospective registry. Two consecutive cohorts were created based on the system used to record acute care AEs; one used ICD-10 coding by hospital coders and the other used SAVES data prospectively collected by a multidisciplinary clinical team. The ICD-10 codes were appropriately mapped to the SAVES. There were 212 patients in the ICD-10 cohort and 173 patients in the SAVES cohort. Analyses were adjusted to account for the different sample sizes, and the two cohorts were comparable based on age, gender and motor score.Results:The SAVES system identified twice as many AEs per person as ICD-10 coding. Fifteen unique AEs were more reliably identified using SAVES, including neuropathic pain (32 × more; P<0.001), urinary tract infections (1.4 × ; P<0.05), pressure sores (2.9 × ; P<0.001) and intra-operative AEs (2.3 × ; P<0.05). Eight of these 15 AEs more frequently identified by SAVES significantly impacted length of stay (P<0.05). Risk factors such as patient age and severity of paralysis were more reliably correlated to AEs collected through SAVES than ICD-10.Conclusion:Implementation of the SAVES system for patients with TSCI captured more individuals experiencing AEs and more AEs per person compared with ICD-10 codes. This study demonstrates the utility of prospectively collecting AE data using validated tools. [ABSTRACT FROM AUTHOR]

Study Design:This study is a literature review and a proposed conceptual model.Objectives:The objective of this study is to develop a conceptual model to explore the relationship between the presence of depressive symptoms and secondary physical complications such as pressure ulcers, urinary tract infections and autonomic dysreflexia in spinal cord injury (SCI).Setting:Community setting for individuals with SCI.Methods:A conceptual model explaining the mechanism underlying the relationship between depression and secondary physical SCI complications was developed based on the International Classification of Functioning, Disability and Health (ICF). A literature review was conducted to develop the model and to identify potential mechanisms responsible for the association.Results:A conceptual model based on ICF was created, informed by the literature discussing the link between depression and secondary physical SCI complications. Evidence in the literature was located that supports both a causal connection between depression and increased physical complications and/or the potential mechanisms mediating that connection.Conclusion:The proposed model can be utilized to encourage further research on the influence of depression on SCI outcomes and the importance of prompt and effective identification and treatment of depressive symptoms. Additional research is needed to assess the relationship between depression and secondary physical SCI complications, and to test the validity of the model. [ABSTRACT FROM AUTHOR]