Holtz Kaila A, Szefer Elena, Noonan Vanessa K, Kwon Brian K, Mills Patricia B
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Emmes Canada, Burnaby, BC, Canada.
Spinal Cord. 2018 Dec;56(12):1176-1183. doi: 10.1038/s41393-018-0165-0. Epub 2018 Jun 14.
Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review.
To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada.
Quaternary trauma center, rehabilitation center.
Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (N = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures.
In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (p < 0.001 for both). Of individuals with cervical and thoracic injuries (n = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005-2009 vs. 2010-2014) have not changed significantly over time.
This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of "real world" anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.
采用里克·汉森脊髓损伤登记处（RHSCIR）进行前瞻性队列研究，并进行回顾性病历审查。
描述加拿大不列颠哥伦比亚省急性和康复医院环境中创伤性脊髓损伤（SCI）后住院抗痉挛药物的使用模式。
四级创伤中心、康复中心。
2005年至2014年在温哥华RHSCIR站点登记的创伤性SCI患者（N = 917）符合纳入条件。口服和注射用抗痉挛药物的使用是主要结局指标。
在769名参与者中，较高的神经损伤水平和损伤严重程度与住院抗痉挛药物的使用相关（两者p均<0.001）。在颈椎和胸椎损伤患者（n = 589）中，37%在住院期间被开具抗痉挛药物。巴氯芬是最常用的一线口服疗法。从受伤到开始使用巴氯芬的平均（标准差）和中位时间分别为70（69）天和50天。受伤后6个月的患者开始使用住院抗痉挛药物的概率为55%（95%置信区间（49, 60）），受伤后12个月的患者为71%（95%置信区间（62, 79））。在社区出院时，口服和注射用抗痉挛药物的使用率分别为26%和5%。抗痉挛药物的使用模式（2005 - 2009年与2010 - 2014年）随时间未发生显著变化。
这是第一项关于创伤性SCI后住院抗痉挛药物使用的大型前瞻性队列研究。我们的研究结果为临床医生和患者提供了创伤性SCI患者“真实世界”中抗痉挛药物使用情况的信息，并可能有助于指导该人群在社区中的护理。
