Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia.
BACKGROUND
Autonomic dysreflexia (AD) is a common problem in patients with spinal cord injury (SCI) above the T6 neurologic level and may cause serious medical complications if untreated. Previous studies have focused on patients with complete SCI.


METHODS
Prospective analysis of a historic cohort. A retrospective review of a subset of the cohort also was performed.


OBJECTIVE
To examine the percentage of persons with complete and incomplete tetraplegia who developed AD and determine whether patients with incomplete injuries were at risk for developing AD; and to study the onset of AD and determine the time period that patients are at risk for developing AD.


METHODS
Data were collected prospectively on 332 patients with tetraplegia to determine American Spinal Injury Association (ASIA) impairment score, neurologic level, presence of AD, and length of hospital stay. The charts of 34 patients who developed AD were then reviewed retrospectively for further data such as onset and contributing factors of AD. Also obtained were data from the National SCI Statistical Center database for comparison of percentage of patients with complete and incomplete injuries who developed AD.


RESULTS
Patients with motor-complete SCI (ASIA A or ASIA B) had a higher percentage of AD (P = 0.001) during their initial hospitalization than did patients with motor-incomplete SCI. However, patients with motor-incomplete injuries also were at risk for developing AD. The onset of AD occurred between 1 and 6 months after injury.


CONCLUSIONS
Patients with incomplete tetraplegia are at risk for developing AD. As hospital lengths of stay decrease, patients may be discharged before onset of symptoms. Patient and family education about AD is, therefore, increasingly important for all patients with tetraplegia.
Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. wmh2@pitt.edu
Wendy M
WM
Helkowski
John F
JF
Ditunno
Michael
M
Boninger
D020211:Autonomic Dysreflexia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D016208:Databases, Factual; D006801:Humans; D007902:Length of Stay; D009043:Motor Activity / Q000502:physiology; D011446:Prospective Studies; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors; D014481:United States / Q000453:epidemiology