PubMed Health⌕ Search

Biomedical subjects

S L Stover

Publications and source records attributed to S L Stover.

At least 37 records · Page 2Linked to original sources
PubMed1990

Benefits of early admission to an organised spinal cord injury care system.

Patients admitted to the University of Alabama Hospital between 1973 and 1985 were studied to determine the benefits, if any, of early admission to an organised, multidisciplinary spinal cord injury (SCI) care system. Patients admitted within 1 day of injury who received all subsequent care within the system were compared with patients who received their acute care services elsewhere and who were admitted to the system solely for rehabilitation. Both patient groups were comparable with respect to age, neurologic level and extent of spinal cord lesion, pre-existing major medical conditions, associated injuries, ventilator dependency and acute surgical procedure experience. Findings included statistically significant reductions in acute care and total lengths of stay coupled with a highly significant reduction in the incidence of pressure ulcers for patients admitted within 1 day of injury. Moreover, for patients admitted within 1 day of injury, mortality rates were lower than reported previously for patients not admitted to an organised SCI care system.

Adult↗
PubMed1990

Effect of bullet removal on subsequent pain in persons with spinal cord injury secondary to gunshot wound.

The prevention or minimization of future pain is often cited as a reason for removal of the bullet from patients who have incurred a spinal cord injury secondary to a gunshot wound. In an attempt to examine this assumption, multimodal pain ratings were recorded for 14 patients with spinal cord injury due to a gunshot wound in whom the bullet was still present, 14 neurologically matched patients with spinal cord injury due to a gunshot wound in whom the bullet was removed, and 28 control patients with spinal cord injury unrelated to a gunshot wound who were neurologically matched to the first two groups. The results suggest that persons who sustain a spinal cord injury secondary to gunshot wounds report more pain than those injured in other ways. In addition, there was no indication that surgical removal of the bullet was helpful in reducing subsequent pain either early in the rehabilitation process or at 1 year postinjury. The location of the bullet and the type of pain that subsequently developed were not correlated with the initial decision to surgically remove the bullet. Implications for further study and clinical practice are discussed.

Foreign Bodies↗
PubMed1990

Anemia in acute phase of spinal cord injury.

Anemia is a frequent complication during the acute phase of spinal cord injury (SCI), even in the absence of detectable blood loss. Since an improved understanding of the etiology of anemia in this population is a prerequisite to its ultimate prevention, a prospective study was conducted on 28 persons with SCI whose lesions were between C3 and C7. The injuries were either neurologically complete, incomplete with sensory sparing only, or incomplete with nonfunctional motor preservation. Laboratory profiles were obtained during the first few weeks postinjury. No persons had below-normal plasma volumes, while 9% had below-normal blood volumes. However, 82% had below-normal red cell masses, 25% had below-normal serum erythropoietin levels, and 11% had below-normal reticulocyte counts. Other below-normal values included erythrocyte count (75%), hemoglobin (79%), hematocrit (71%), mean corpuscular volume (11%), mean corpuscular hemoglobin (11%), serum iron (50%), total iron binding capacity (86%), iron saturation (50%), serum total protein (57%), serum albumin (89%), serum globulin (32%), and serum transferrin (79%). Most persons (71%) were found to have normochromic, normocytic anemia, although 14% had normochromic, microcytic anemia. Only 14% did not develop anemia. Although these cases of anemia were not severe enough to require transfusions, they might be an important factor in the development of other secondary complications and may combine with other nutritional and hematologic deficiencies to prolong the rehabilitation process.

Adult↗
PubMed1989

The relationship between sponsorship and rehabilitation outcome following spinal cord injury.

The effect of sources of support on rehabilitation outcomes of 866 patients treated at the University of Alabama at Birmingham Spinal Cord Injury Care System since 1973 was assessed using multiple linear and logistic regression. System admission was delayed for Medicaid beneficiaries, while patients who were responsible for at least a portion of their incurred charges were admitted sooner than other patients. Increased lengths of stay were noted among vocational rehabilitation clients and patients with either Workers' Compensation or private insurance coverage. Patients with Workers' Compensation also had significantly higher average hospital charges. Medicaid patients were more likely to be rehospitalised after discharge from rehabilitation. Vocational rehabilitation clients averaged fewer days in nursing homes after injury while Medicaid and Medicare patients experienced longer stays in nursing homes. We conclude that source of support has a significant impact on numerous measures of outcome.

Humans↗
PubMed1989

Urinary tract infection in spinal cord injury.

Loss of normal bladder function results in increased risk of developing urinary tract infection. Recurrent bacteriuria continues to be a problem in most spinal cord injured persons regardless of the bladder emptying method used. Lower urinary tract complications have decreased with intermittent catheterization, but the effect of increased intravesical pressure and presence of bacteriuria on renal function are still undetermined. Current methods of neurogenic bladder management are often based on professional or institutional presuppositions rather than scientific data. Although there are many unanswered questions about the role of urinary tract infection in spinal cord injury patients, treatment should be based on scientific knowledge, even though the knowledge base is still limited. Preservation of renal function is the ultimate goal of any method of neurogenic bladder management. Although a person with spinal cord injury is described, the material covered is applicable to other neurogenic bladder disturbances.

Humans↗
PubMed1989

Cause of death for patients with spinal cord injuries.

An epidemiologic study of 5131 patients sustaining spinal cord injuries between 1973 and 1980 was conducted to determine and characterize the leading causes of death in this population. Patients who were studied had been admitted to one of seven federally designated regional spinal cord injury care systems and they survived for at least 24 hours after injury. When follow-up was terminated, 459 patients (9%) had died. Overall, the leading cause of death was pneumonia, followed by other subsequent unintentional injuries and suicides. The highest ratios of actual to expected deaths were for septicemia, pulmonary emboli, and pneumonia. Pneumonia was the leading cause of death among quadriplegics and persons at least 55 years of age, while among paraplegics and persons who were less than 55 years of age, subsequent unintentional injuries and suicides were the leading causes of death. While there is conclusive evidence that mortality rates for spinal-cord injured persons have declined dramatically since the end of World War II, many cause-specific mortality rates remain substantially above normal.

Adult↗
PubMed1989

Nutritional status during the acute stage of spinal cord injury.

This study was designed to help clinicians establish objective guidelines for meeting the nutritional requirements of spinal cord injury (SCI) patients during their initial hospitalizations. The nutritional status of 51 SCI patients treated between 1983 and 1986 was assessed at two, four, and eight weeks after injury. Nutrient deficiencies such as albumin (100% of patients), carotene (62%), transferrin (37%), ascorbate (25%), thiamine (24%), folate (20%), and copper (11%) were documented most frequently at two weeks postinjury. There was an average of 2.0, 1.6, and 1.2 nutrient abnormalities per patient at two, four, and eight weeks postinjury, respectively. Although most depressed nutrient parameters improved with time, diet-dependent plasma proteins such as albumin and transferrin remained low throughout the entire eight-week period. Mean body weight declined 1.3 +/- 3.9 kg during the first two weeks, 2.0 +/- 4.4 kg between two and four weeks, and 0.4 +/- 2.0 kg between four and eight weeks after injury. Significant findings also included a strong correlation between plasma albumin, ascorbate, and carotene levels and maximal inspiratory and expiratory pressure (p less than .05). Although nutrient status usually improved with time and was not definitely associated with an increased risk of secondary medical complications, prudence dictates that these deficiencies should be prevented by appropriate intervention.

Adolescent↗
PubMed1988

Undiagnosed spinal cord injuries in brain-injured children.

Four children with brain injury were later found to have coexisting spinal cord injury (SCI). Findings that warrant investigation for coexisting SCI include a dermatome pattern sensory loss; absence of movement and reflexes in either both arms or both legs with preservation in the remaining extremities; flaccidity; absence of sacral reflexes; diaphragmatic breathing without use of accessory respiratory muscles; bradycardia with hypotension; autonomic hyperreflexia; poikilothermia; unexplained urinary retention; history of neck pain; unexplained ileus; priapism; and the presence of clonus in an unconscious patient without decerebrate rigidity. If any of the above are present, the spine should be stabilized until either further diagnostic studies confirm SCI with treatment instituted or serial neurologic examinations confirm the absence of SCI.

Brain Injuries↗
PubMed1987

Seven-year survival following spinal cord injury.

This retrospective study of 5131 persons who sustained a spinal cord injury between 1973 and 1980 sought to determine the overall seven-year survival rate and the effect of several prognostic factors on survival. All study subjects had been treated at one of seven federally designated Model Regional Spinal Cord Injury Care Systems and each had survived at least 24 hours after injury. The cumulative seven-year survival was 86.7%. Advancing age at time of injury and being rendered a neurologically complete quadriplegic were significant prognostic factors. The cumulative seven-year survival among neurologically complete quadriplegics who were at least 50 years of age when injured, was only 22.7%. Spinal cord injury mortality rates ranged from 3.26 to 20.78 times higher than corresponding rates for nonspinal injured persons. Although mortality rates for spinal cord injury patients have declined dramatically since World War II, life expectancies for these patients are still substantially below normal.

Adolescent↗
PubMed1987

Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury.

Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.

Dilatation, Pathologic↗
PubMed1987

A methodology for predicting lengths of stay for spinal cord injury patients.

Although the focus of Medicare's prospective payment system is on acute care hospitalization, other health care delivery systems are likely to be included in the future. In this paper, we report on a model for predicting length of stay (LOS) for spinal cord injury patients requiring hospitalization and rehabilitation services. Using multiple regression on data on 2,169 patients from the National Spinal Cord Injury Statistical Center data base, we predicted LOS for seven injury severity groups, and then validated our results with a second sample of 505 patients. Our predictive model explained a robust 45% of the variance in LOS and adjusted hospital charges. We conclude that our model would be useful in projecting LOS for patients whose injuries or illnesses require extensive rehabilitation services after acute care.

Adult↗
PubMed1987

Arthritis related interests in spinal cord injury.

National concern about traumatic spinal cord injury almost 2 decades ago led federal authorities to establish the Regional Spinal Injury Care Systems and a common database to study this condition. Thirteen years of collaborative data collection have provided valuable experience and information for the planning of spinal cord injury research. This approach may also apply to other categories of patients who have multiple variables associated with the clinical picture, treatment and outcome, and in whom the demonstration of treatment effectiveness requires longterm studies of large numbers of patients. Certain complications seen in patients with spinal cord injury including heterotopic ossification, joint changes, and dermal fibrosis, may provide models for the understanding of certain bone and collagen diseases.

Arthritis↗
PubMed1987

Employment after spinal cord injury.

A predictive model for employment after spinal cord injury was developed. The study population consisted of 154 spinal cord injured persons who were treated at our hospital between 1973 and 1979, and followed for seven years after injury. Demographic, social, and injury severity data were abstracted from each subject's hospital record. Motivation to work, employment history, and sources of postinjury financial support, were assessed by a vocational rehabilitation counselor. The study population was divided into four groups: persons continuously unemployed after injury, homemakers, students, and those employed at some time during the seven-year follow-up period. Stepwise discriminant analysis was used to develop a predictive model that ultimately included seven variables: gender, motivation to work, whether the patient's last job required ambulation, race, educational level, a functional ability score, and whether the patient had children. The model correctly classified 82% of those persons who were continuously unemployed, 100% of homemakers, 63% of students, and 72% of employed subjects. Overall, 79% of subjects were classified correctly. The most important classification errors were between the unemployed and employed groups. Seventeen percent of employed patients were incorrectly classified as unemployed, and 11% of unemployed patients were incorrectly classified as employed. Although there are other determinants of postinjury vocational status, individual potential can be assessed by means of a comparatively small set of predictor variables.

Adolescent↗
PubMed1986

Iatrogenic dilatation of the upper urinary tract during radiographic evaluation of patients with spinal cord injury.

Patients with upper and lower motor neuron spinal cord injuries were observed to determine whether cystography immediately before excretory urography induced iatrogenic dilatation of the upper urinary tract that was indistinguishable from true pathological dilatation. Evidence is given that such dilatation occurs. This iatrogenic dilatation is not seen in patients with normally innervated urinary tracts and appears to be caused by exaggerated bladder reflexes in patients with upper motor neuron lesions. Bladder spasms precipitated by cystographic contrast material also may create vesicoureteral obstruction and lead to dilatation of the upper urinary tract. Consequently, it is suggested that cystography should not immediately precede excretory urography. When such a sequence is necessary, room or body temperature contrast medium should be used for the cystogram, the bladder should be emptied before the excretory urogram is started and a 1-hour interval should be allowed between the 2 procedures. The findings also suggest that any factors that induce repeated or continuing bladder spasms may contribute to progressive dilatation of the upper urinary tract.

Contrast Media↗
PubMed1986

Initial bladder management in spinal cord injury: does it make a difference?

We classified 204 patients with acute spinal cord injury into 1 of 5 groups according to the initial form of urological management. Group A patients were placed on an intermittent catheterization program within 36 hours of injury, group B received a suprapubic trocar within 36 hours of injury, group C had urethral catheters in place for more than 36 hours before intermittent catheterization was begun, group D was on indwelling urethral catheter drainage throughout the hospitalization and discharged from the hospital with indwelling catheters, and group E was placed on intermittent catheterization in a community hospital. There were no statistically significant differences among the groups in the incidence of chills and fever, rate of urinary infections (excluding group D), incidence of upper tract changes, genitourinary complications or frequency of urological procedures at 1 year after injury. We conclude that the method of initial bladder management is relatively unimportant in determining the urological prognosis after spinal cord injury.

Adolescent↗