Deterioration following XXXX . A multicenter study.

@entity1 @entity4215 @entity1566 @entity717 @entity130
The results are presented of a prospective study of the course of 283 spinal cord-injured @entity1 who were consecutively admitted to five @entity130 centers participating in the Comprehensive Central @entity4215 Centers' program of the National Institutes of Health. Of the 283 @entity1 , 14 deteriorated neurologically during acute hospital management. In 12 of the 14, the decline in neurological function could be associated with a specific management event, and in nine of these 12 the injury involved the cervical cord. Nine of the 14 @entity1 who deteriorated had cervical injuries, three had @entity1566 , and two had thoracolumbar junction injuries. Management intervention was identified as the cause of deterioration in four of 134 @entity1 undergoing operative intervention, in three of 60 with skeletal traction application, in two of 68 with halo vest application, in two of 56 undergoing Stryker frame rotation, and in one of 57 undergoing @entity717 . Early surgery on the cervical spine when @entity1566 is present appears hazardous, since each of the three @entity1 with a cervical @entity1566 who deteriorated was operated on within the first 5 days. No such deterioration was observed following surgery performed from the 6th day on. In two other @entity1 , deterioration did not appear to be related to management but was a direct product of the underlying disease or of systemic complications. Deterioration following hospitalization for @entity1566 is relatively uncommon--4.9% in this large series. In most instances, decline in function could be attributed to specific management procedures. These changes must not be interpreted as representing failure to provide optimal care but rather should be seen as the inevitable product of an attempt to manage @entity1 with spinal cord and column injuries, many of which are clearly unstable.
