Secondary medical complications after traumatic spinal cord injury in Stockholm, Sweden: Towards developing prevention strategies
Kerstin Wahman, Lena Nilsson Wikmar, Giorgi Chlaidze, Conran Joseph
Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden
Objectives: (i) To determine the prevalence of secondary complications after traumatic spinal cord injury during acute care and rehabilitation; (ii) to investigate whether associations exist between level and completeness of injury and the development of common complications; and (iii) to assess whether associations exist between secondary complications and return-to-work 1 year after injury.
Design and participants: A prospective, population-based study, including all newly-injured persons with traumatic spinal cord injury for an 18-month period.
Methods: The International Spinal Cord Injury Core Data Set was used to capture injury characteristics, as well as associated injuries and neurological severity. All secondary medical complications (e.g. pressure injuries, pulmonary embolism, pneumonia, urinary tract infection) were screened for during acute care and rehabilitation. Inferential statistics were carried out.
Results: Out of the 45 persons undergoing acute care, the 3 most common complications were urinary tract infections (47%), pneumonia (22%) and neuropathic pain (18%). Of the 31 persons who received rehabilitation, the most common complications were urinary tract infections (42%), neuropathic pain (42%), and spasticity (35%). A significant association was found between injury level and development of neuropathic pain during rehabilitation.
Conclusion: Although a specialized system for spinal cord injury management is available in Sweden, secondary complications are still common. These findings could be used to inform the development of strategies for prevention of secondary complications.
Development of secondary complications is common after acute traumatic spinal cord injury. The presence of secondary complications may influence one’s livelihood and quality of life. This study examined the nature and number of secondary complications among persons with acute traumatic spinal cord injury throughout the care pathway in Sweden. All patients with a traumatic spinal cord injury were observed for 18 months and followed through acute, inpatient rehabilitation, up until 12 months after injury. Certain secondary complications, such as urinary tract infections, pneumonia, neuropathic pain, were common during acute care and rehabilitation. Subjects with tetraplegia reported neuropathic pain more than those with paraplegia during both phases of care. In conclusion, complications occur despite the specialized system of care for persons with traumatic spinal cord injury in Sweden. This information should be used to develop and implement appropriate prevention programmes.
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