Incidence of pulmonary embolism after the first 3 months of spinal cord injury.

BACKGROUND: Pulmonary embolism (PE) is a significant cause of morbidity and mortality in patients with spinal cord injury (SCI). Prophylactic anticoagulation is associated with a reduction in mortality rates, but there is limited evidence regarding the incidence rate of PE following cessation of anticoagulation after the first 3 months of injury. STUDY DESIGN: Single-centre retrospective study. OBJECTIVE: To estimate the incidence rate of PE after 90 days of SCI. SETTING: The National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury, UK. METHODS: The study includes 640 new-onset SCI patients. All computer tomography pulmonary angiograms (CTPAs) or ventilation-perfusion lung scans between 2008 and 2013 were identified. Medical notes and scans were reviewed and clinical outcomes and radiological findings were recorded. RESULTS: A total of 91 patients with a new-onset SCI had a CTPA or a perfusion lung scan. PE was detected in a total of 8 patients. The incidence of PE was 1.25%; 95% confidence interval (0.39-2.11) over a 6-year period. The duration of injury at the time of PE was 7 months. CONCLUSION: The incidence rate of PE post 3 months of SCI remains significant, though much lower than immediately post injury.

Posterior circulation infarction in patients with traumatic cervical spinal cord injury and its relationship to vertebral artery injury.

STUDY DESIGN: Prospective study. OBJECTIVE: To ascertain the prevalence of posterior circulation stroke in traumatic chronic spinal cord injured (SCI) patients and associated traumatic vertebral artery injuries (VAI). METHODS: All adult patients with cervical SCI and American Spinal Injury Association Impairment Scale (AIS) grade A or B referred for follow-up magnetic resonance imaging of their spinal cord were invited to take part in the study between January 2010 and December 2012 at the National Spinal Injury Centre. Two additional sequences were added to the existing imaging protocol to evaluate the brain and vertebral arteries. RESULTS: Ninety-eight patients were recruited. All imaging were analysed independently by three consultant radiologists. Posterior circulation infarcts were noted in seven (7%) patients. Significant VAI was noted in 13 patients (13%) with 10 occlusions and 3 with high-grade stenosis. However, only one patient had co-existent posterior circulation infarct and significant VAI. CONCLUSION: There is an increased prevalence of posterior circulation infarction in SCI patients. The relationship with associated traumatic VAI requires further investigation.

Outcomes of whole-body computed tomography in spinal cord-injured patients with sepsis.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To evaluate the efficacy of body computed tomography (CT) in spinal cord injury (SCI) patients with sepsis. SETTING: Specialist acute care and rehabilitation SCI centre in United Kingdom. METHODS: Patients with SCI and suspected or known sepsis, who had CT of the chest, abdomen and pelvis, over a 4-year period, were identified. Only patients who fulfilled the definition of sepsis or severe sepsis were included. Their medical notes and CT scans were reviewed and clinical outcomes and radiological findings recorded. RESULTS: Twenty-two patients with sepsis were identified including seven categorised as having severe sepsis. A specific radiological diagnosis was found in three patients (14%) and non-specific findings were found in 15 patients (68%). CONCLUSION: Although in the majority of cases, the findings were non-specific, a small number of patients had significant pathology identified by CT, which influenced their management significantly.