title: [Preclinical diagnosis of traumatic paraplegia or tetraplegia -- a prospective study in 100 patients].
abstract: OBJECTIVE
  To avoid neurological deterioration, traumatic spinal cord injury has to be recognized as early as possible. Aim of the study was to analyze alterations of the neurological level of injury in the preclinical interval.
  
  
  METHODS
  In a prospective observational study the clinical diagnoses of 100 patients referred to the Swiss Paraplegic Centre in Nottwil, Switzerland, were compared to the preclinical diagnoses.
  
  
  RESULTS
  In 12 patients we observed neurological deterioration for more than 2 spinal segments. Six of these patients had been diagnosed preclinically with paraplegia at a neurological level of T4 or T5, whereas the evaluation in the hospital showed cervical spinal cord injury and tetraplegia.
  
  
  CONCLUSIONS
  Possible reasons for this neurological deterioration can be secondary damages of the nervous tissue due to vascular, metabolic or biochemical mechanisms, transportation trauma or insufficient preclinical diagnostics. There is no evidence for a higher risk of secondary tissue damage for patients with cervical spinal cord injury. None of the six patients had additional injuries of the spinal cord or the vertebral column in the thoracic region, therefore transportation trauma is also unlikely. It is more likely that preclinical diagnoses were incorrect, what could have been avoided by consequent sensory and motor testing at the upper extremities.
authors.affiliation: Schweizer Paraplegiker-Zentrum Nottwil, Schweiz. peter.felleiter@paranet.ch
authors.forename: P
authors.initials: P
authors.lastname: Felleiter
authors.forename: C
authors.initials: C
authors.lastname: Reinsberger
authors.forename: D
authors.initials: D
authors.lastname: Springe
authors.forename: H
authors.initials: H
authors.lastname: Plunien
authors.forename: M
authors.initials: M
authors.lastname: Baumberger
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018450:Disease Progression; D004282:Documentation; D004632:Emergency Medical Services / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010264:Paraplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011446:Prospective Studies; D011782:Quadriplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D013119:Spinal Cord Injuries / Q000175:diagnosis; D013557:Switzerland; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000150:complications* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone