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Venous thromboembolism after spinal cord injury.

Arch Phys Med Rehabil. 2009 Feb;90(2):232-45

Authors: Teasell RW, Hsieh JT, Aubut JA, Eng JJ, Krassioukov A, Tu L,

OBJECTIVE: To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI). DATA SOURCES: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool. STUDY SELECTION: Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available. DATA EXTRACTION: Data extracted included demographics, the nature of the study intervention, and study results. DATA SYNTHESIS: Levels of evidence were assigned to the interventions using a modified Sackett scale. CONCLUSIONS: Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.

PMID: 19236977 [PubMed - indexed for MEDLINE]

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Inpatient cancer rehabilitation: a retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients.

Arch Phys Med Rehabil. 2008 Jul;89(7):1284-9

Authors: Alam E, Wilson RD, Vargo MM

OBJECTIVE: To determine whether patients with diagnoses of neoplasm undergoing acute rehabilitation differ from other patients in frequency of acute care transfer and type of medical complications. DESIGN: Retrospective cohort analysis. SETTING: Acute rehabilitation hospital located within an academic medical center. PARTICIPANTS: Patients with diagnosis of neoplasm (n=40) and patients without neoplasm (n=253) requiring transfer were identified from a database of 2801 rehabilitation discharges over nearly a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frequency of unplanned transfer and reasons for the transfer. RESULTS: Significant difference occurred in overall rate of transfer between patients with neoplasm (21%) and controls (9.7%; P<.001). When evaluated separately for type of neoplasm (with patients receiving corresponding type of rehabilitation as controls), a significantly higher rate of transfer to acute care was found for brain tumor (25% vs 12%; P=.004) and spinal cord neoplasms (23% vs 10%; P=.009), but statistical significance was not reached for other tumor types (12.5% vs 7.4%; P=.19). Patients with stroke with neoplasm as a comorbidity, analyzed separately, with the other patients with stroke as controls, had significantly higher risk of transfer (22% vs 10%; P=.012). Logistic regression analysis found an odds ratio (OR) of 2.5 for unplanned transfer among patients with diagnosis of neoplasm (OR=2.5 for malignancy; OR=2.4 for benign neoplasm). Patients with neoplasm had infection as the most common reason for transfer (28% of the neoplasm transfers vs 18% of other transfers; P=.01), whereas in the nonneoplasm group, cardiopulmonary factors predominated (12% of patients with tumor vs 31% of patients without tumor transfers; P<.001). CONCLUSIONS: In the present sample, patients with neoplasm were more likely to require transfer than patients without neoplasm, although this pattern did not reach statistical significance for noncentral nervous system cases. Overall, patients with neoplasm appear more likely than those without neoplasm to have an infectious cause for unplanned transfer. Increased awareness of this difference may lead to improved medical management on rehabilitation units.

PMID: 18586130 [PubMed - indexed for MEDLINE]

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