Medicine (RMH) - Theses
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ItemReducing acute respiratory complications in thoracolumbar spinal cord injury( 2018)Acute traumatic thoracolumbar spinal cord injury (TLSCI) is a devastating event, generally resulting in severe neurological deficits and often profoundly impacting respiratory function. Whilst relatively rare, each new case is associated with an average cost of 5.0 million Australian dollars over a person’s lifetime. Advancements in emergency, surgical and medical care now result in near-normal life expectancy after traumatic paraplegia in the developed world. Due to the ageing population, prevalence is projected to increase, further compounding the disease burden of TLSCI worldwide. Pneumonia is the dominant complication following TLSCI, particularly in the early weeks following injury. However, the prevalence of pneumonia in TLSCI is variably reported (2-31%) due to its dependence on diagnostic criteria. Pneumonia severity is generally proportional to the degree and duration of hypoxaemia and fever, both of which have been associated with elevated morbidity and mortality in central nervous system injuries, and therefore have the potential to inflict significant secondary spinal cord damage and negatively influence long term neurological outcome. Surgical timing, injury severity, neurological level of injury and comorbidity burden have been demonstrated in the literature to influence pneumonia development. Interventions aimed at preventing pneumonia in the acute hospital setting are resource-intensive and difficult to justify as a blanket intervention due to cost. The synthesis of a pneumonia prediction tool identifying a subset of patients at medium and high risk of pneumonia would provide opportunity for early, systematic and targeted interventions in a smaller group that have the greatest potential to positively respond. The overarching aim of this thesis is to improve the respiratory management of patients with TLSCI in the acute hospital setting. By exploring the timing of surgery and the complex interplay of other risk factors involved in clinically important pneumonia development, this thesis aims to develop a clinical prediction tool based on simple baseline factors, enabling early identification of high risk patients and subsequently facilitating resource allocation into prophylactic interventions in a smaller subset of individuals with TLSCI.