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dc.contributor.authorJentzsch, Thorsten
dc.contributor.authorCadotte, David W
dc.contributor.authorWilson, Jefferson R
dc.contributor.authorJiang, Fan
dc.contributor.authorBadhiwala, Jetan H
dc.contributor.authorAkbar, Muhammad A
dc.contributor.authorRocos, Brett
dc.contributor.authorGrossman, Robert G
dc.contributor.authorAarabi, Bizhan
dc.contributor.authorHarrop, James S
dc.contributor.authorFehlings, Michael G
dc.date.accessioned2021-10-28T17:26:56Z
dc.date.available2021-10-28T17:26:56Z
dc.date.issued2021-10-18
dc.identifier.issn2077-0383
dc.identifier.urihttp://hdl.handle.net/10713/16999
dc.description.abstractPrognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31-3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28-0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16-0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.en_US
dc.description.urihttps://doi.org/10.3390/jcm10204778en_US
dc.language.isoenen_US
dc.publisherMDPI AGen_US
dc.relation.ispartofJournal of Clinical Medicineen_US
dc.subjectMRIen_US
dc.subjectmagnetic resonance imagingen_US
dc.subjectneurologyen_US
dc.subjectoutcomeen_US
dc.subjectparalysisen_US
dc.subjectspinal cord injuriesen_US
dc.subjectwalkingen_US
dc.titleSpinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patientsen_US
dc.typeArticleen_US
dc.identifier.doi10.3390/jcm10204778
dc.source.volume10
dc.source.issue20
dc.source.countrySwitzerland


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