Spinal Cord Injuries Caused by Penetrating Mechanisms Result in More Pressure-Related Injury and Infections

Author(s):
Melissa Canas; Ricardo Fonseca; ShengXiang Huang; Leonardo Diaz; Hussain Afzal; Michael Alchaer; Marguerite Spruce; Grant Bochicchio; Keith A Kranker; Lindsay M Kranker

Background:

The majority of spinal cord injuries (SCI) are caused by blunt trauma mechanisms, but those caused by penetrating injury are associated with a higher morbidity and disability. Patients with SCI are highly susceptible to pressure-related injury (PRI) due to reduced mobility and sensation, which can result in further complications, including infection.

Hypothesis:

Patients with SCI resulting from penetrating trauma are at higher risk of pressure-related injury/infection as compared to blunt injury.

Methods:

Level 1 Trauma SCI patients admitted from 2018 to 2022 were evaluated and stratified by mechanism of injury. A matched comparison group approach was used to compare rates of complications in the first post-injury year (including PRI, associated infection, and operative debridement) between patients with penetrating SCI and patients with blunt SCI who resembled those with penetrating SCI in terms of Injury Severity Score (ISS), level of injury (cervical, thoracic, or lumbar), gender, race, insurance status and Social Vulnerability Index (SVI).

Results:

Blunt SCI patients were significantly more likely to be older (62 vs 31 years, p<0.001), white (73% vs 9%, p<0.001), less injured (ISS 10.6 vs 21.9, p<0.001), less socially vulnerable (SVI 0.47 vs 0.71, p<0.001) and insured (85% vs 50%, p<0.001).  76 penetrating SCI patients were well matched to 199 blunt patients (n= 275) for level of injury, gender, ISS, age, and insurance status. Matching could not fully correct for differences in race and SVI, penetrating SCI patients were still more likely to be black (68% vs 27%, p<0.001) and have a higher SVI (0.71 vs 0.54, p<0.001). After matching, penetrating SCI patients were more likely to have been discharged to inpatient rehabilitation (49% vs 19%, p<0.001) but were still more likely to develop PRIs (25% vs 8%, p<0.001) and subsequent infection (9% vs 3%, p=0.030) within one year after initial injury. The most common organisms found were Pseudomonas aeruginosa and Bacteroides spp in penetrating SCI, and Bacteroides spp and Enterococci faecalis in blunt SCI.

Conclusions:

Patients with penetrating SCI are at increased risk for the diagnosis of pressure-related injury and associated infection within one year of injury. Further investigation is required to determine the cause(s) of this increased risk. Prevention and treatment strategies need to be developed to mitigate this high risk of morbidity and mortality.