title: Impact of multiple injuries on functional and neurological outcomes of patients with spinal cord injury.
abstract: BACKGROUND
  The effects of multiple injuries on the neurological and functional outcomes of patients with traumatic spinal cord injury (SCI) are debated-some groups have shown that subjects with multiple injuries have the same neurological and functional outcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries.
  
  
  METHODS
  A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student's T test was used to compare the outcomes of patients divided by AIS impairment and lesion level.
  
  
  RESULTS
  SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinations. The separate analysis per each level of lesion/AIS grade showed that in some groups, patients with multiple injuries had a significant longer length of stay or worse functional status at rehabilitation admission (but not at discharge) than their monotraumatic counterparts.
  
  
  CONCLUSIONS
  Multiple injuries do not affect the neurological or rehabilitative prognosis of spinal cord injuries. At discharge, patients with spinal cord injuries with and without multiple injuries achieved similar results with regard to neurological and functional improvement. Some groups of patients with multiple injuries had a longer length of stay.
authors.affiliation: Spinal Cord Unit, IRCCS S, Lucia Foundation, Rome, Italy. g.scivoletto@hsantalucia.it
authors.forename: Giorgio
authors.initials: G
authors.lastname: Scivoletto
authors.forename: Sara
authors.initials: S
authors.lastname: Farchi
authors.forename: Letizia
authors.initials: L
authors.lastname: Laurenza
authors.forename: Federica
authors.initials: F
authors.lastname: Tamburella
authors.forename: Marco
authors.initials: M
authors.lastname: Molinari
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000534:rehabilitation / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries; D016896:Treatment Outcome