From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC.
Neurol Neuroimmunol Neuroinflamm. 2021 Aug 31;8(6). doi: 10.1212/NXI.0000000000001071. Print 2021 Nov.
To characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA).
This retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria.
We identified 4,084 patients with an code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2-4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes ( = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57-2.40) and tobacco use (OR 1.87, 95% CI, 1.17-2.99).
This national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.
描述美国退伍军人事务部（VHA）内横贯性脊髓炎（TM）的人群水平数据。
本回顾性研究使用了 1999 年至 2015 年 VHA 的电子病历。我们根据 2002 年的诊断标准，分析了 TM 患者的患病率、疾病特征、改良 Rankin 量表（mRS）评分和死亡率数据。
我们在 4084 名有 TM 编码的患者中发现了 1001 名（90.7%为男性，中位年龄 64.2 岁，67.7%为白种人，31.4%为吸烟者）患者确诊为 TM。时点患病率为每 10 万人 7.86 例。不到一半的患者接受了腰椎穿刺，而只有 31.8%的患者最终被诊断为与疾病相关的 TM。症状发作时的中位 mRS 评分为 3 分（四分位间距 2-4），随访时无变化，尽管只有不到一半（43.2%）的患者接受了皮质类固醇、IVIg 或血浆置换。大约四分之一的患者（24.3%）患有纵向广泛 TM，这与较差的预后相关（=0.002）。在我们的研究中，共有 108 名患者（10.8%）死亡（94.4%为男性，中位年龄 66.5%，70.4%为白种人）。死亡率与随访时较高的 mRS 评分（OR 1.94，95%CI，1.57-2.40）和吸烟有关（OR 1.87，95%CI，1.17-2.99）。
这项全国性的 TM 综述强调了在现代队列中 TM 相对较高的患病率。它还强调了在这种致残性疾病中进行精确和彻底的评估的重要性，以确保诊断的准确性，并确保未来 TM 患者的最佳管理。
