Long-term medical complications after traumatic spinal cord injury: A regional model systems analysis

Objective: To analyze the incidence, risk factors, and trends of long-term secondary medical complications in individuals with traumatic spinal cord i njury. Design: Data were reviewed from the National SCI Statistical Center on annu al evaluations performed at I, 2, 5, 10, 15, and 20 years after injury on p atients injured between 1973 and 1998. Setting: Multicenter Regional SCI Model Systems. Main Outcome Measures: Secondary medical complications at annual follow-up years, including pneumonia/atelectasis, autonomic dysreflexia, deep venous thrombosis, pulmonary embolism, pressure ulcers, fractures, and renal calcu li. Results: Pressure ulcers were the most frequent secondary medical complicat ions in all years, and individuals at significant (p<.05) risk included tho se with complete injuries (years 1, 2, 5, 10), younger age (year 2), concom itant pneumonia/atelectasis (year 1, 2, 5), and violent injury (years 1, 2, 5, 10). The incidence of pneumonia/atelectasis was 3.4% between rehabilita tion discharge and year-1 follow-up with those most significantly at: risk being older than 60 years (years 1, 2, 5, 10) and tetraplegia-complete (yea rs 1, 2). One-year incidence of deep venous thrombosis was 2.1% with a sign ificant decline seen at year 2 (1.2%), and individuals most significantly ( p<.001) at risk were those with complete injuries (year I). The incidence o f calculi (kidney and/or meter) was 1.5% at 1-year follow-up and 1.9% at 5 years and was more frequent in patients with complete tetraplegia. Intermit tent catheterization was the most common method of bladder management among patients with paraplegia but became less common at later postinjury visits . Conclusions: Pressure ulcers, autonomic dysreflexia, and pneumonia/atelecta sis were the most common long-term secondary medical complications found at annual follow-ups. Risk factors included complete injury, tetraplegia, old er age, concomitant illness, and violent injury. (C) 1999 by the American C ongress of Rehabilitation Medicine and the American Academy of Physical Med icine and Rehabilitation.