title: Hemodynamic parameters and timing of surgical decompression in acute cervical spinal cord injury.
abstract: OBJECTIVE
  To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of neurogenic shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial.
  
  
  METHODS
  Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP).
  
  
  RESULTS
  Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with neurogenic shock (SBP < 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P < 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP < 90 mmHg and 58 hours for patients with initial SBP > or = 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D.
  
  
  CONCLUSIONS
  The presence of neurogenic shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes.
authors: ICORD, University of British Columbia, Vancouver, BC, Canada.
authors: Sagun
authors: S
authors: Tuli
authors: Jayshree
authors: J
authors: Tuli
authors: William P
authors: WP
authors: Coleman
authors: Fred H
authors: FH
authors: Geisler
authors: Andrei
authors: A
authors: Krassioukov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D019299:Decompression, Surgical; D004632:Emergency Medical Services; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012769:Shock / Q000150:complications; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors