The Effects of Concomitant Traumatic Brain Injury (TBI) on the Epidemiology of Spinal Cord Injury (SCI), Access to Treatment Services, and Outcomes After Acute Traumatic SCI: A Propensity-score Matched Cohort Study Using Data from a Canadian National Registry
Objective:
This study examined the effects of concomitant TBI on injury epidemiology, management and outcomes of individuals with traumatic SCI.
Background:
Concomitant TBI is common but its impact on the outcomes post-SCI remains under-studied.
Design/Methods:
A propensity-score matched cohort study was performed to compare a SCI+TBI group (n=1018) with a SCI-only group (n=3687), which were matched on 1:1 ratio using the propensity score matching by age, sex, severity and level of SCI, and Charlson Comorbidity Index. TBI was defined as a Glasgow coma score (GCS) below 15 at the admission. Both groups were compared regarding injury epidemiology (injury mechanism, ethnicity, GCS, other body injuries), management (mechanical ventilation, skeletal traction, Methylprednisone, surgical treatment, time to surgical decompression), and outcomes post-SCI (length of stay [LOS], International Standards for Neurological Classification of SCI [ISNCSCI] motor subscore, Functional Independence Measure, discharge destination, and spasticity and pain at discharge).
Results:
Data analysis revealed that being white (OR=5.332, p=0.0265) is associated with being in TBI+SCI group, while having other body injuries (OR=0.095, p=0.0065) is associated with being in SCI-only group. The odds of participants dying in hospital is 2.442 times higher for the TBI+SCI group. Although TBI+SCI group has longer LOS in an acute care facility, both groups had similar LOS in a rehabilitation center. The risk of being discharge to a nursing home/long-term care setting of TBI+SCI group is 1.949 times higher. Concomitant TBI does not influence change in ISNCSCI motor subscore from initial admission to final discharge. The odds of individuals with pain is 1.52 times higher for the TBI+SCI group. However, the presence of spasticity is not different between the groups.
Conclusions:
This study highlights significant differences between the TBI+SCI group and the SCI-only group regarding the injury epidemiology, survival, discharge disposition, and pain. Nonetheless, both groups had similar access to treatment services, motor recovery, and spasticity.