title: Presentation of neurogenic shock within the emergency department.
abstract: BACKGROUND
  Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings.
  
  
  OBJECTIVE
  To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment.
  
  
  METHODS
  The Trauma Audit and Research Network database for an adult major trauma centre was used to isolate patients with a spinal cord injury. Qualifying patients had all available BPs and HRs collated into a database. Patients with neurogenic shock were isolated, allowing data analysis.
  
  
  RESULTS
  Out of 3069 trauma patients, 33 met the inclusion criteria, of which 15 experienced neurogenic shock. 87% of the patients who had neurogenic shock experienced it within 2 hours of injury. Neurogenic shock below the T6 level was less common (p=0.009); however, there were still four cases in the cohort. More patients with complete spinal cord injury had neurogenic shock (p=0.039).
  
  
  CONCLUSIONS
  Neurogenic shock is variable and unpredictable. It can present in the prehospital environment and without warning in a patient with previously normal vital signs. The medical team should be aware of it in all patients with spinal cord injury regardless of injury level.
authors.affiliation: Medical Teaching Centre, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Matthew Pritam
authors.initials: MP
authors.lastname: Taylor
authors.affiliation: Emergency Department, University Hospital Coventry and Warwickshire, Coventry, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wrenn
authors.affiliation: Medical Teaching Centre, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Andrew David
authors.initials: AD
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012769:Shock / Q000209:etiology* / Q000503:physiopathology*; D013116:Spinal Cord / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000209:etiology; D013997:Time Factors; D006113:United Kingdom
keywords: neurology, spinal; prehospital care