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February 3, 2017
COLUMBUS, Ohio – New research led by The Ohio State University Wexner Medical Center identified hospital-acquired pneumonia and wound infections to negatively affect the clinical long-term outcome after acute traumatic spinal cord injury.
Findings of the longitudinal multi-center cohort study are published online in the journal Neurology.
“These findings provide the first extensive prospective analytical evidence that hospital-acquired infections are predictive for worse outcome with respect to both survival and long-term functional outcome after spinal cord injury,” said principal investigator Jan M. Schwab, MD PhD, neurologist and clinical-scientist at Ohio State’s Neurological Institute who collaborated with researchers from Germany and the University of Alabama in Birmingham. “Infections thus qualify as a targetable outcome-modifying factor whose prevention can be regarded as a strategy to protect function and reduce mortality.”
Researchers investigated whether infections with onset during the acute hospitalization period restrict the patients’ recovery of physical independence. They analyzed the infection-associated mortality during a period of 10 years following each patient’s spinal cord injury. Data of patients with acute traumatic spinal cord injuries were collected in specialized spinal cord injury care centers nationwide.
Patients enrolled into the National Spinal Cord Injury Database (NSCID) within one day after spinal cord injury had been assigned to long-term follow-up. The NSCID is the world’s largest prospective patient registry following individuals for up to more than 30 years and comprises data on pneumonia or postoperative wound infection and motor items of the Functional Independence Measure long-term outcome.
Within this group, 564 patients (47%) developed pneumonia and/or wound infections during their acute medical and rehabilitative inpatient care. Of this group, 540 are classified as pneumonia, 11 as postoperative wound infection, and 13 as pneumonia and postoperative wound infection.
“We demonstrated that patients are not able to compensate even long-term for the effect of a pneumonia acquired during the acute phase,” Schwab said. “Moreover, the risk of dying as a consequence of an acquired pneumonia is extending far beyond one year, and remains significantly elevated for even up to 10 years after an injury.
The research team included members from Charité – Universitatsmedizin Berlin and Eberhard Karls Universität Tübingen, both in Germany, and the National Spinal Cord Injury Statistical Center at the University of Alabama at Birmingham.