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Prevention of AD in Acute Care

The primary mechanisms of SCI are irreversible, therefore, prevention of AD in acute care are mainly focused on the attenuation of the effects of secondary injuries which are delayed, prolonged, and reversible.

 

Table 14: Prevention of AD in Acute Care

Author Year; Country
Score
Research Design
Sample Size
MethodsOutcome
Chen et al. 2012;

China

Pre-Post

(Multiple Groups)

N=295

Population: 295 adults who underwent surgical decompression for acute traumatic SCI; mean (SD) age in yrs: 42.11(13.75); sex (ratio): 1.63:1 (male: female); preoperative AIS: A (n=135), B (n=29), C (n=36), D (n=95); preoperative ASIA motor index total score: 42.64(27.02); preoperative motor score of injured level: 4.02(0.46); preoperative sensory score of injured level: 3.02(0.45).

Treatment: cases were extracted and assigned into 3 groups on the basis of the timing of surgery: Urgent group (n=99, within 8 h after injury), Early group (n=86, from 8h to 48 h after injury), Delayed group (n=110, after 48 h); neurological outcomes and medical complications were compared before the operation, after the operation, at 6 months, and at 1 year.

Outcome Measures: ASIA motor index total score; ASIA Impairment Scale (AIS); Motor and sensory scores of injured level; medical complications.

1.     Deep vein thrombus (DVT), hypostatic pneumonia, autonomic dysreflexia, and pressure ulcers were the most commonly seen medical complications of surgical decompression.

2.     Morbidity of autonomic dysreflexia increased with time because of delayed injuries; it was still lower in the urgent and the early groups than in the delayed group, because urgent and early surgical decompression blocked secondary injury mechanisms in time.

3.     Urgent and early surgical decompression lowered the increase in the morbidity of autonomic dysreflexia more effectively than delayed surgical decompression.(Post-operatively: urgent=5.9%; early=5.4%; delayed=9.7%. At 6 months: urgent=5.7%; early=5.3%; delayed=9.7%)

Discussion

One prospective study (Chen et al. 2012, n=295) examined differences in morbidity of AD in patients with acute SCI treated with surgical decompression at different times (urgent, early and delayed). The study found that patients in the urgent and early surgical decompression groups had lower AD incidence post-operatively and at 6 months follow-up.

Conclusion

There is level 4 evidence from one prospective study (Chen et al. 2012) that earlier surgical decompression after acute SCI results in decreased AD incidence as compared to delayed surgical compression.