Incidence of acute care complications in vertebral column fracture patients with and without spinal cord injury.

STUDY DESIGN: This study retrospectively analyzed vertebral column fractures in trauma patients during a 2-year period. Data from a multicenter trauma registry were used. OBJECTIVES: The purpose of this study was to ascertain and describe the initial in-hospital morbidity and mortality rates for patients with vertebral column fractures with and without spinal cord injury. SUMMARY OF BACKGROUND DATA: Patients with vertebral fractures and associated spinal cord injuries experience more medical complications than those without spinal cord injuries. However, the precise incidence and relative risk of complications during acute care hospitalization for these two groups are not well documented. METHODS: Vertebral column fractures in 419 adolescent and adult trauma patients hospitalized during a 2-year period were retrospectively analyzed using data from a multicenter trauma registry. RESULTS: Of the 419 patients, 104 (24.8%) had an associated spinal cord injury. More than half of the spinal cord injury patients (52.9%) and 20.6% of those without spinal cord injury had one or more complications during their hospitalization. Complications resulted in an average of 33.1 extra hospital days, which extrapolates nationally into 1.5 million additional days annually. The four complications differing most significantly in incidence between the spinal cord injury group and the non-spinal cord injury group were: urinary tract infections (24.0% vs. 8.6%), respiratory (23.1% vs. 8.6%), cardiac (11.5% vs. 3.2%), and decubitus ulcer (7.7% vs. 1.0%). Pneumonia, although not statistically different, was high in both groups (13.5% vs. 7.3%). CONCLUSIONS: The incidence of the 25 types of medical complications reported here provides specific and relevant information to assist health professionals in treating patients during their acute care. We estimate that complications during initial hospitalization add $1.5 billion annually to the cost of caring for patients with vertebral fractures in the United States.

Does an unfavorable metabolic environment for red cells develop within the cat spleen when abnormal cells become trapped?

Intrasplenic pH, blood gas tensions, and glucose concentration were deduced from measurements of blood drained from cat spleen during contraction with the inflow occluded. During this procedure the hematocrit of the outflow rises gradually from 35% to 40% (arterial) to 75% to 80%, the last fraction representing a pure sample of blood from the splenic pulp. In normoxic animals no evidence was found of an unfavorable metabolic environment for red cells within the spleen on account of low pH, low O2 tension, and substrate deprivation, as is generally believed. However, red cell flow through the red pulp can be impeded rheologically after sequestration of 10(9) heat-treated (HT) autologous red cells, and we have tested the hypothesis that under these conditions the availability of O2 and glucose might be reduced and a decline in pH might occur. One hour after injection of the HT cells into the splenic artery, splenic contraction was induced with the arterial inflow occluded; the blood expelled from the splenic vein was collected anaerobically as successive 1 ml fractions. Values of pH, O2 tension, and glucose concentration in the final samples expelled were not significantly different from those in corresponding samples from control spleens. Thus, even when stasis of 50% of intrasplenic red cells occurs, caused by the sequestration of 10(9) abnormal cells, no hostile metabolic environment develops within the red pulp. Presumably the residual plasma flow through the pulp is sufficient to maintain a normal metabolic environment.