Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study.

STUDY DESIGN: Retrospective review of medical notes. OBJECTIVE: To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). SETTING: Inpatient rehabilitation unit of tertiary research hospital. METHODS: Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. RESULTS: The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. CONCLUSION: Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study.

STUDY DESIGN: Retrospective, 12-year case series. OBJECTIVE: To compare neurological and functional outcomes, and complications of patients with traumatic vs non-traumatic spinal cord injury (SCI) after in-patient rehabilitation. SETTING: In-patient rehabilitation unit of a tertiary research hospital. MATERIALS AND METHODS: The sample consisted of 165 newly injured patients with traumatic and non-traumatic spinal cord lesions whose medical records were retrospectively reviewed. Demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) subgroup scores, length of stay and medical complications in both groups were compared. RESULTS: In all, 38 patients (23%) were non-traumatic and 127 patients (77%) were traumatic in etiology. Compared with patients with traumatic SCI (mean age 37.81±13.65 years), patients with non-traumatic SCI (mean age 53.97±14.48 years) were significantly older (P<0.05). Incomplete SCI was significantly higher in the non-traumatic group when compared with the traumatic group (P<0.001). In the non-traumatic group, admission motor FIM scores were significantly higher (28.29±16.04) than scores from the traumatic group (36.60±21.65; P=0.029); however, there was no significant difference in discharge motor FIM scores between the two groups (P=0.140). ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.000 and P=0.000, respectively). The length of hospital stay was significantly shorter in the non-traumatic group (P=0.002). CONCLUSION: According to the results of this study, although patients with non-traumatic SCI had shorter length of stay and higher ASIA scores, there was no significant difference in functional outcomes between traumatic and non-traumatic SCI patients.