title: Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury.
abstract: METHODS
  A retrospective, multicenter study.
  
  
  OBJECTIVE
  To investigate the relationship between bowel and bladder management methods and symptomatic autonomic dysreflexia (AD) during hospitalization in patients with spinal cord injury (SCI).
  
  
  METHODS
  Twenty-eight Rosai hospitals in Japan.
  
  
  METHODS
  The study subjects were 571 patients with SCI who had been admitted to 28 Rosai hospitals between April 1997 and March 2007 for rehabilitation therapy and fulfilled the following criteria: (1) SCI at or above sixth thoracic level, (2) discharged from hospital after more than 4 months of admission for initial injury and (3) lack of pressure ulcers, deep venous thrombosis, ureteral and renal stones or heterotopic ossification throughout hospitalization to exclude possible influence of these complications on cardiovascular reflexes. The study subjects were examined for the incidence of symptomatic AD according to age, sex, ASIA Impairment Scale, injury level, bowel and bladder management techniques at discharge.
  
  
  RESULTS
  The Rosai Hospital registry included 3006 persons with SCI during 1997-2007, and 571 patients fulfilled the above criteria. The highest incidence of symptomatic AD was diagnosed in subjects using reflex voiding and in those using manual removal of stool. By contrast, the lowest incidence of symptomatic AD was in those on continent spontaneous voiding and continent spontaneous defecation.
  
  
  CONCLUSIONS
  Medical staff should evaluate the presence of AD in patients with SCI at or above the T6 level under bladder and bowel management such as reflex voiding and manual removal of stool.
authors.affiliation: Kibikogen Rehabilitation Center for Employment injuries, Okayama, Japan. furusawa@kibirihaH.rofuku.go.jp
authors.forename: K
authors.initials: K
authors.lastname: Furusawa
authors.forename: A
authors.initials: A
authors.lastname: Tokuhiro
authors.forename: H
authors.initials: H
authors.lastname: Sugiyama
authors.forename: A
authors.initials: A
authors.lastname: Ikeda
authors.forename: F
authors.initials: F
authors.lastname: Tajima
authors.forename: E
authors.initials: E
authors.lastname: Genda
authors.forename: R
authors.initials: R
authors.lastname: Uchida
authors.forename: T
authors.initials: T
authors.lastname: Tominaga
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.forename: A
authors.initials: A
authors.lastname: Magara
authors.forename: M
authors.initials: M
authors.lastname: Sumida
mesh_terms: D000328:Adult; D000368:Aged; D020211:Autonomic Dysreflexia / Q000175:diagnosis / Q000453:epidemiology*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000534:rehabilitation*