Journal of neurotrauma
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Journal of neurotrauma · Sep 2023
Associations between diurnal timing of spinal cord injury and its etiology and co-morbidities.
Circadian rhythms play a role in time-of-day differences in risk, presenting severity and outcomes of stroke. Injury time-of-day effects, however, on occurrence, presenting severity and acute hospital outcomes have not been yet reported in patients with neurotrauma. Therefore, acute post-spinal cord injury hospitalization records of 759 patients from the prospective NACTN registry that contained information about the time of injury were analyzed. ⋯ These data suggest diurnal modulation of spinal cord injury risk because of specific mechanisms such as falls or sports-related accidents. Moreover, some co-morbidities may interact with those injury mechanisms as exemplified by the established risk elevation of falls in those with diabetes mellitus. Finally, while diurnal timing of the injury may modulate presenting severity, more patient records are needed to verify those effects.
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Journal of neurotrauma · Sep 2023
An Introduction to the North American Clinical Trials Network for Spinal Cord Injury Special Edition: Reflections on Accomplishments and a Look to the Future.
The North American Clinical Trials Network (NACTN) has been established as a network of translational clinical research centers focused on traumatic spinal cord injury (SCI) with the goals of facilitating clinical translational research, promotion of enhanced clinical care protocols including the principle of early surgery for SCI, and improving outcomes for individuals with acute SCI. Since its foundation in 2004 by Dr. Robert Grossman, NACTN has evolved into a powerful multi-stakeholder consortium of eight neurosurgical department faculties at university-affiliated institutions in the United States and Canada, a data management center, and a pharmacological center. ⋯ The Focus Issue also includes a detailed analysis of the pharmacokinetics and pharmacodynamics of riluzole in the setting of acute SCI (RISCIS-PK study). Additional achievements include key contributions to the evidence supporting the role of early surgery in acute SCI, and a better understanding of the impact of complications on the outcomes of SCI. Future directions of NACTN will build on past accomplishments and focus on enhanced collaborations with other SCI networks, advanced analytics to examine large datasets, and a greater focus on chronic SCI.
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Journal of neurotrauma · Sep 2023
ReviewThe Importance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care.
Only 100 years ago, traumatic spinal cord injury (SCI) was commonly lethal. Today, most people who sustain SCI survive with continual efforts to improve their quality of life and neurological outcomes. SCI epidemiology is changing as preventative interventions reduce injuries in younger individuals, and there is an increased incidence of incomplete injuries in aging populations. ⋯ They've also revealed latent disease-modifying factors, helped develop clinical trial stratification models, and served as matched control groups in clinical trials. Advancing SCI clinical science for personalized medicine requires advanced analytical techniques, including machine learning, counterfactual analysis, and the creation of digital twins. Registries and other data sources help drive innovation in SCI clinical science.
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Journal of neurotrauma · Sep 2023
ReviewThe bulbocavernosus reflex (BCR) has no prognostic features during the acute evaluation of spinal cord injuries.
The bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock." This reflex has been less utilized over the last decade, and therefore a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. ⋯ In addition, cohorts were not different in surgery decision (p = 0.7762) and injury to surgery time (p = 0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury.
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Journal of neurotrauma · Sep 2023
The Evolving Profile of Acute Spinal Cord Injury Demographics, Outcomes and Surgical Treatment in North America: Analysis of a Prospective Multicenter Dataset of 989 Patients.
Changes in demography and injury patterns have altered the profile and outcome of acute spinal cord injury (SCI) over time. This study sought to describe recent trends in epidemiology and early clinical outcomes using the multi-center North American Clinical Trial Network (NACTN) for Spinal Cord Injury Registry. All participants with blunt acute traumatic SCI (n = 782) were grouped into three five-year time intervals from 2005 to 2019 (2005-2009, 2010-2014, and 2015-2019). ⋯ There was a statistically significant increase in cardiac complications (p < 0.0001) and decrease in pulmonary complications (p < 0.0001) during the study period. Data from the NACTN registry shows that the age of participants with acute SCI is increasing, falls have become the major mechanism of injury, and central cord injury is becoming increasingly prevalent. While early surgical intervention for acute SCI is more common in recent years, cardiac complications are more prevalent while pulmonary complications are less prevalent.