Early Rapid Neurological Assessment for Acute Spinal Cord Injury Trials.

Autor:	Battistuzzo CR; 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia ., Smith K; 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia ., Skeers P; 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia ., Armstrong A; 3 School of Animal Biology, The University of Western Australia , Perth, WA, Australia ., Clark J; 4 Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide , Adelaide, SA, Australia ., Agostinello J; 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia ., Cox S; 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia ., Bernard S; 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia ., Freeman BJ; 4 Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide , Adelaide, SA, Australia .; 5 Department of Orthopaedics and Trauma, Royal Adelaide Hospital , Adelaide, SA, Australia ., Dunlop SA; 3 School of Animal Biology, The University of Western Australia , Perth, WA, Australia ., Batchelor PE; 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia .
Jazyk:	angličtina
Zdroj:	Journal of neurotrauma [J Neurotrauma] 2016 Nov 01; Vol. 33 (21), pp. 1936-1945. Date of Electronic Publication: 2016 May 16.
DOI:	10.1089/neu.2015.4360
Abstrakt:	Clinical trials evaluating early therapies after spinal cord injury (SCI) are challenging because of the absence of a rapid assessment. The aim of this study was to determine whether the severity and level of SCI could be established from a brief neurological assessment capable of being used in an emergency setting. A brief assessment called the SPinal Emergency Evaluation of Deficits (SPEED) was developed and retrospectively evaluated in a cohort of 118 patients with SCI. Foot motor and sensory function was used to indicate injury severity. C3 dermatome sensation, handgrip strength and location of spinal pain were used to indicate the level of injury. With regard to injury severity, a high proportion of patients (94%) with no foot movement at the time of injury were initially diagnosed as motor complete (American Spinal Injury Association Impairment Scale [AIS] grade A-B), whereas all patients with foot movement were identified as motor incomplete (AIS grade C-D). This was reflected by a good correlation (r s  = 0.79) and agreement (κ = 0.85) between the SPEED motor score and the acute hospital assessment. With respect to injury level, the majority of cases with cervical SCI (92%) had no or weak handgrip at the time of paramedic assessment, whereas all cases with thoracolumbar SCI had a strong handgrip. The location of spinal pain was also in accordance with the level of spinal injury. The SPEED assessment appears capable of accurately determining the severity and level of cervical SCI in the first hours post-injury. A neurological assessment that can be performed rapidly after injury is important for clinical trials of early therapy and to identify patients most likely to benefit from intervention.
Databáze:	MEDLINE
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