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[Abstract] Objectives: To analyze the relationship between neurological progression following traumatic spinal cord injury and Spinal Cord Compression (SCC) and Spinal Ligamentous Injury (LI) by magnetic resonance imaging. Design: Retrospective observational study. Setting: Spinal Cord Injury Unit (A Coruña, Spain). Participants: Patients were admitted for traumatic spinal cord injury between January 2010 and December 2018 with a magnetic resonance imaging examination performed during the acute phase. Intervention: Evaluation of SCC and LI by magnetic resonance imaging. Outcome measures: Comparisons between neurological examination at admission and discharge were made, assessing ASIA Impairment Scale (AIS) grade and motor score. Results: Data from 296 patients were collected. A relationship between SCC and LI and complete injuries were found (P < 0.001). Improvement of the AIS grade was observed in 31.6% of patients with SCC and 31.3% with LI versus 42.7% and 37.8% of subjects without these complications, respectively. Regarding motor score, patients with SCC had lower mean values at the beginning (46.9 ± 26.8 versus 61.1 ± 29.9 in the control group, P < 0.001), as well as less improvement when assessed by the percentage of change (35.1 ± 37.5% versus 49.4 ± 38.1% in the control group, P = 0.010). Similar results were obtained in cases with LI: mean motor score at admission was 45.9 ± 26.7 versus 54.9 ± 29.4 in the control group (P = 0.014) and the percentage of change was 28.5 ± 37.1% in comparison to 46.0 ± 37.5% (P = 0.001) in the controls. Conclusions: There is a relationship between SCC and LI and complete spinal cord injury. This patient population has lower possibilities of improving their AIS grade and motor score.

[Resumen] Objetivo. Valorar en individuos con lesión medular traumática (LMT) la relación entre la mortalidad y la necesidad de UCI y las alteraciones objetivadas mediante resonancia magnética (RM) precoz, analizando alteraciones parenquimatosas, disrupción de ligamentos vertebrales (DLV) y compresión del cordón medular (CCM). Diseño. Estudio retrospectivo. Ámbito. Hospital de tercer nivel, unidad de lesionados medulares y UCI. Pacientes. Individuos con LMT aguda entre los años 2010 y 2019. Intervenciones. Análisis de RM realizada en las primeras 72 horas. Variables de interés. Ingreso en UCI y mortalidad. Resultados. Recogidos 269 casos. El patrón que se asoció a una mayor mortalidad fue la hemorragia (16,7%) por 12,5% de los edemas a un nivel y 6,5% de los edemas a múltiples niveles (p = 0,125). Lo mismo aconteció con los ingresos en UCI: 69,0% en hemorragia por 60,2% en edema múltiple y 46,3% en edemas cortos (p = 0,018). Con respecto a la CCM, la mortalidad fue del 13,4% con 59,2% de ingresos en UCI por 2,2% y 42,2% de quienes no presentaban compresión (p = 0,020 y p = 0,003). Las cifras de éxitus e ingreso en UCI en los individuos con DLV fueron del 15,0% y el 67,3%, respectivamente, por un 6,2% y 44,4% de los individuos sin DLV (p < 0,001 y p = 0,013). Conclusiones. La presencia de hemorragia medular, CCM y DLV se asoció a una mayor necesidad de UCI. Existe un significativo aumento de la mortalidad en los casos con CCM y DLV., [Abstract] Objective. To assess in individuals with traumatic spinal cord injury (TSCI) the relationship between mortality and need for ICU and early magnetic resonance imaging (MRI), analyzing spinal parenchymal alterations, disruption of vertebral ligaments (DVL) and spinal cord compression (SCC). Design. Retrospective study. Setting. Third-level hospital, Spinal Cord Injury Unit and ICU. Patients. Individuals with acute TSCI between 2010 and 2019. Intervention. Analysis of MRI performed in the first 72 h. Variables of interest. Admission to ICU and mortality. Results. 269 cases collected. The pattern that demonstrated higher mortality was cord hemorrhage (16.7%) for 12.5% of single-level edema and 6.5% of multilevel edema (p = 0.125). The same happened with ICU admissions: 69.0% in hemorrhage, 60.2% in multilevel edema and 46.3% in short edema (p = 0.018). Analyzing CCM, mortality was 13.4% with 59.2% of ICU admissions, for 2.2% and 42.2% of individuals without cord compression (p = 0.020 and p = 0.003). The figures of death and ICU admission among cord injuries with DVL were 15.0% and 67.3%, for 6.2% and 44.4% of the individuals without DLV (p < 0.001 and p = 0.013). Conclusions. The presence of spinal cord hemorrhage, SCC and DVL was associated with a higher admission in ICU. A significant increase in mortality was observed in cases with SCC and DVL.

[Abstract] Study design: Descriptive retrospective study. Objectives: To analyze risk factors associated with mechanical ventilation (MV) in cases of acute traumatic Cervical Spinal Cord Injury (tCSCI). Setting: Unidad de Lesionados Medulares, Complejo Hospitalario Universitario A Coruña, in Galicia (Spain). Methods: The study included patients with tCSCI who were hospitalized between January 2010 and December 2014. The following variables were analyzed: age, gender, etiology, neurological level, ASIA (American Spinal Injury Association) grade, associated injuries, injury severity score (ISS), ASIA motor score (AMS) at admission and mortality. Results: A total of 146 patients met the study's inclusion criteria. The majority were men (74.7%) with mean age of 62.6 (s.d. ± 18.8) years. Sixty patients (41.1%) required MV. Mean age of ventilated vs. non-ventilated patients was 57.3 vs. 65.7. Men were more likely to require MV than women, ASIA grades A and B were also more likely to need MV than grades C and D, as well as patients with associated injuries. The AMS of patients receiving MV was lower than that of those who did not require MV (20.1 vs. 54.3). Moreover, the ISS was higher in patients receiving MV (31.2 vs. 13.4). An AMS ≤ 37 and an ISS ≥ 13 increased the risk of requiring MV by a factor of 11.98 and 7.28, respectively. Conclusions: Isolated factors associated with a greater risk of MV in tCSCI were: age, gender, ASIA grade, ISS and AMS. However, the only factor with a significant discriminatory ability to determine the need for MV was the AMS at admission.

BACKGROUND: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard. The main aim of this work is to determine the percentage of inadequate admissions and stays in hospital for the four most frequent Diagnosis-Related Groups (DRGs) in a maternity-children's hospital through the retrospective application of the paediatric version of the Adequacy Evaluation Protocol (AEP). METHOD: It was a retrospective study in which 353 out of the 361 medical records that made up the covered population were analysed. Chi-square and linear trend were the statistical analysis methods used. A variance analysis and the Scheffé multiple comparison test were applied to the average values obtained. RESULTS: The admissions were judged to be adequate in 284 (80.5%) of the cases and inadequate in 69 (19.5%). Of the stays in hospital, 76% were deemed to be appropriate and 24% inappropriate. In DRG 030 (stupor and trauma-related coma, coma<1 hour, age 0-17), a direct relation can be found between the length of the stay in hospital and the inappropriate use of hospitalisation. CONCLUSIONS: The results of this study show that a substantial proportion of the use of the hospital is inappropriate and that, particularly in DRG 030, this use is probably handled in an overly conservative way., FUNDAMENTO: Existe un amplio consenso en que una parte de la utilización de los recursos hospitalarios es inadecuada, en el sentido de que los pacientes reciben servicios que no les proporcionan beneficios significativos, o bien, que podrían ser más beneficiosos, o menos costosos, en un nivel asistencial inferior. El objetivo principal de este trabajo es determinar, mediante la aplicación retrospectiva de la versión pediátrica del Protocolo de Evaluación de la Adecuación (AEP), el porcentaje de ingresos y estancias inadecuadas de los 4 Grupos Relacionados con el Diagnóstico (GDR) más frecuentes en un hospital materno-infantil. MÉTODO: Se trata de un estudio retrospectivo en el que se analizan 353 historias clínicas (HC) de las 361 que constituyen la población de estudio. Como análisis estadístico se utiliza Chi cuadrado y análisis de tendencia lineal. Sobre las medias obtenidas se aplicó un análisis de la varianza y la prueba de comparación múltiple de Scheffé. RESULTADOS: Las admisiones fueron juzgadas como adecuadas en 284 (80,5%) de los casos e inadecuadas en 69 (19,5%). El 76% de las estancias revisadas fueron juzgadas como apropiadas y el 24% como inapropiadas. En el GDR 030 (estupor y coma de origen traumático, coma<1 hora, edad 0-17) se aprecia una relación directa entre duración de la estancia y uso inapropiado de la hospitalización. CONCLUSIONES: De los resultados de este estudio se desprende que una sustancial proporción de la utilización en el hospital es inapropiada y que, particularmente en el GDR 030, es probable se esté efectuando un manejo especialmente conservador.