RESUMEN
STUDY DESIGN: Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. OBJECTIVES: To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000-2004. SETTING: SCI rehabilitation service, Tel Hashomer, Israel. METHODS: Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. RESULTS: Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. CONCLUSIONS: Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.
Asunto(s)
Traumatismos por Explosión/diagnóstico , Explosiones/estadística & datos numéricos , Traumatismos de la Médula Espinal/diagnóstico , Médula Espinal/patología , Terrorismo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Traumatismos por Explosión/fisiopatología , Traumatismos por Explosión/rehabilitación , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Radiografía , Recuperación de la Función/fisiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Médula Espinal/diagnóstico por imagen , Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Resultado del Tratamiento , Adulto JovenRESUMEN
STUDY DESIGN: Prospective study. OBJECTIVE: To identify and define dermatological conditions following acute traumatic spinal cord injury (ATSCI) during inpatient rehabilitation. SETTING: Spinal Cord Injury Unit, The Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Israel. METHODS: During a 1-year study, all patients following ATSCI were prospectively studied for new dermatological findings during their inpatient rehabilitation. Every new dermatological finding was defined concerning its location with regard to the patient's neurological level, the time from injury to appearance and the exact dermatological diagnosis. RESULTS: During the study year, 46 ATSCI patients were hospitalized in our department, of whom were 38 (82.6%) males and eight (17.4%) females (mean age 30.2 years). A total of 21 (45.6%) patients were tetraplegic and 25 (54.3%) paraplegic. Of the patients, 28 (60.9%) had complete neurological injuries and 18 (39.1%) incomplete. In all, 14 (30.4%) patients developed a dermatological condition. There was no significant age or sex correlation to the development of these complications. There was a greater likelihood of paraplegia (48 versus 9.5%, P=0.005) and being neurologically complete (42.9 versus 11.1%, P=0.02). The dermatological findings appeared on an average of 80.3 days after the initial neurological insult. There were a total of 22 different dermatological findings: 11 (50%) were local fungal infections, two (9.1%) psoriatic lesions, two (9.1%) hyperkeratotic lesions, two (9.1%) bacterial infections (one folliculitis, one impetigo) and single cases of seborrheic dermatitis, acne, alopecia, scabies and allergic reaction. Of the findings, 14 (63.6%) were below the neurological level, including all of the fungal infections. CONCLUSIONS: Dermatological findings are common during rehabilitation of ATSCI. The clinical impact of these findings is low, but nevertheless, they are troublesome to the patient. The most common dermatological disorder was a local fungal infection below the neurological level. Paraplegic patients are more susceptible to the development of this condition. Patient and staff education regarding proper skin care may reduce these infections.