COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

Korupolu, Radha; Stampas, Argyrios; Gibbons, Carlee R; Hernandez Jimenez, Isaac; Skelton, Felicia; Verduzco-Gutierrez, Monica

doi:10.1038/s41394-020-0284-7

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COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

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Author(s): Radha Korupolu ¹ ^, ² ^, , Argyrios Stampas ¹ ^, ² , Carlee Gibbons ³ , Isaac Hernandez Jimenez ¹ ^, ² , Felicia Skelton ⁴ ^, ⁵ , Monica Verduzco-Gutierrez ³

Publication date (Electronic): 11 May 2020

Journal: Spinal Cord Series and Cases

Publisher: Nature Publishing Group UK

Keywords: Spinal cord diseases, Viral infection

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Abstract

An outbreak of a novel coronavirus disease (COVID-19) that emerged in the Chinese city of Wuhan has rapidly become a global public health pandemic. As of March 2020, the Centers for Disease Control and Prevention (CDC) has described priority levels for testing patients with suspected COVID-19 and information on when to seek medical attention. However, there is a paucity of further guidance for people with spinal cord injury (SCI) who may not present with typical symptoms of COVID-19 due to altered physiology. This may pose challenges with surveillance, risk stratification, and initial management of this vulnerable population. In this point-counterpoint discussion, we outline important differences in presentation along with COVID-19 cases co-morbid with SCI.

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Most cited references 20

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Chronic complications of spinal cord injury.

Nebahat Sezer, Selami Akkuş, Fatma Uğurlu (2015)

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients' functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

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A systematic review of the management of autonomic dysreflexia after spinal cord injury.

Andrei Krassioukov, Darren E R Warburton, Robert Teasell … (2009)

To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD). A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD. Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded. Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers. Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E(2)). A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.

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Respiratory problems and management in people with spinal cord injury

David Berlowitz, Brooke Wadsworth, Jack Ross (2016)

Spinal cord injury (SCI) is characterised by profound respiratory compromise secondary to the level of loss of motor, sensory and autonomic control associated with the injury. This review aims to detail these anatomical and physiological changes after SCI, and outline their impact on respiratory function. Injury-related impairments in strength substantially alter pulmonary mechanics, which in turn affect respiratory management and care. Options for treatments must therefore be considered in light of these limitations. Key points Respiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness. Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise. The mainstays of management following acute high cervical SCI are tracheostomy and ventilation, with noninvasive ventilation and assisted coughing techniques being important in lower cervical and thoracic level injuries. Prompt investigation to ascertain the extent of the SCI and associated injuries, and appropriate subsequent management are important to improve outcomes. Educational aims To describe the anatomical and physiological changes after SCI and their impact on respiratory function. To describe the changes in respiratory mechanics seen in cervical SCI and how these changes affect treatments. To discuss the relationship between injury level and respiratory compromise following SCI, and describe those at increased risk of respiratory complications. To present the current treatment options available and their supporting evidence.

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Author and article information

Contributors

Radha Korupolu: radha.korupolu@uth.tmc.edu

Journal

Journal ID (nlm-ta): Spinal Cord Ser Cases

Journal ID (iso-abbrev): Spinal Cord Ser Cases

Title: Spinal Cord Series and Cases

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2058-6124

Publication date (Electronic): 11 May 2020

Publication date Collection: 2020

Volume: 6

Electronic Location Identifier: 35

Affiliations

[1 ]GRID grid.468222.8, Department of Physical Medicine and Rehabilitation, McGovern Medical School, , The University of Texas Health Science Center, ; Houston, TX USA

[2 ]ISNI 0000 0004 0434 8100, GRID grid.414053.7, The Institute of Rehabilitation & Research (TIRR) Memorial Hermann, ; Houston, TX USA

[3 ]GRID grid.468222.8, Department of Rehabilitation Medicine, Long School of Medicine, , The University of Texas Health Science Center, ; San Antonio, TX USA

[4 ]ISNI 0000 0004 0420 5521, GRID grid.413890.7, Center for Innovations in Quality, Effectiveness and Safety, , Michael E. DeBakey VA Medical Center, ; Houston, TX USA

[5 ]ISNI 0000 0001 2160 926X, GRID grid.39382.33, H. Ben Taub Department of Physical Medicine and Rehabilitation, , Baylor College of Medicine, ; Houston, TX USA

Author information

Monica Verduzco-Gutierrez http://orcid.org/0000-0003-0964-5908

Article

Publisher ID: 284

DOI: 10.1038/s41394-020-0284-7

PMC ID: 7212840

SO-VID: f6688fb7-ce00-4d0b-9ef9-2b290525ca68

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.