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Biomedical subjects

P R Fine

Publications and source records attributed to P R Fine.

At least 37 records · Page 2Linked to original sources
PubMed1987

Seven-year survival following spinal cord injury.

This retrospective study of 5131 persons who sustained a spinal cord injury between 1973 and 1980 sought to determine the overall seven-year survival rate and the effect of several prognostic factors on survival. All study subjects had been treated at one of seven federally designated Model Regional Spinal Cord Injury Care Systems and each had survived at least 24 hours after injury. The cumulative seven-year survival was 86.7%. Advancing age at time of injury and being rendered a neurologically complete quadriplegic were significant prognostic factors. The cumulative seven-year survival among neurologically complete quadriplegics who were at least 50 years of age when injured, was only 22.7%. Spinal cord injury mortality rates ranged from 3.26 to 20.78 times higher than corresponding rates for nonspinal injured persons. Although mortality rates for spinal cord injury patients have declined dramatically since World War II, life expectancies for these patients are still substantially below normal.

Adolescent↗
PubMed1987

Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury.

Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.

Dilatation, Pathologic↗
PubMed1987

A methodology for predicting lengths of stay for spinal cord injury patients.

Although the focus of Medicare's prospective payment system is on acute care hospitalization, other health care delivery systems are likely to be included in the future. In this paper, we report on a model for predicting length of stay (LOS) for spinal cord injury patients requiring hospitalization and rehabilitation services. Using multiple regression on data on 2,169 patients from the National Spinal Cord Injury Statistical Center data base, we predicted LOS for seven injury severity groups, and then validated our results with a second sample of 505 patients. Our predictive model explained a robust 45% of the variance in LOS and adjusted hospital charges. We conclude that our model would be useful in projecting LOS for patients whose injuries or illnesses require extensive rehabilitation services after acute care.

Adult↗
PubMed1987

Employment after spinal cord injury.

A predictive model for employment after spinal cord injury was developed. The study population consisted of 154 spinal cord injured persons who were treated at our hospital between 1973 and 1979, and followed for seven years after injury. Demographic, social, and injury severity data were abstracted from each subject's hospital record. Motivation to work, employment history, and sources of postinjury financial support, were assessed by a vocational rehabilitation counselor. The study population was divided into four groups: persons continuously unemployed after injury, homemakers, students, and those employed at some time during the seven-year follow-up period. Stepwise discriminant analysis was used to develop a predictive model that ultimately included seven variables: gender, motivation to work, whether the patient's last job required ambulation, race, educational level, a functional ability score, and whether the patient had children. The model correctly classified 82% of those persons who were continuously unemployed, 100% of homemakers, 63% of students, and 72% of employed subjects. Overall, 79% of subjects were classified correctly. The most important classification errors were between the unemployed and employed groups. Seventeen percent of employed patients were incorrectly classified as unemployed, and 11% of unemployed patients were incorrectly classified as employed. Although there are other determinants of postinjury vocational status, individual potential can be assessed by means of a comparatively small set of predictor variables.

Adolescent↗
PubMed1986

Predicting renal calculus occurrence in spinal cord injury patients.

This case-control study develops a model to predict the occurrence of renal calculi in patients with spinal cord injury (SCI). Risk factors were assessed at the time of diagnosis in 25 patients who developed calculi, and at a comparable postinjury time period in 100 patients with SCI who remained calculus-free several years after injury. Logistic regression analysis was used to develop a predictive model; accuracy was assessed by using the model to classify all 125 patients studied. Renal calculi occurred more frequently on the right side and 72% of the affected patients developed a second calculus within two years. Patients who developed renal calculi were more likely to be older, have neurologically complete quadriplegia, have Klebsiella or Serratia infections, a history of bladder calculi, and high serum calcium values. The predictive model was 84% sensitive and 81% specific. While other determinants of renal calculi undoubtedly exist, these findings demonstrate that high risk patients may be identified with a comparatively small set of predictor variables. Although these findings are encouraging, use of any predictive model is meant only to supplement and not replace clinical judgement.

Humans↗
PubMed1986

Iatrogenic dilatation of the upper urinary tract during radiographic evaluation of patients with spinal cord injury.

Patients with upper and lower motor neuron spinal cord injuries were observed to determine whether cystography immediately before excretory urography induced iatrogenic dilatation of the upper urinary tract that was indistinguishable from true pathological dilatation. Evidence is given that such dilatation occurs. This iatrogenic dilatation is not seen in patients with normally innervated urinary tracts and appears to be caused by exaggerated bladder reflexes in patients with upper motor neuron lesions. Bladder spasms precipitated by cystographic contrast material also may create vesicoureteral obstruction and lead to dilatation of the upper urinary tract. Consequently, it is suggested that cystography should not immediately precede excretory urography. When such a sequence is necessary, room or body temperature contrast medium should be used for the cystogram, the bladder should be emptied before the excretory urogram is started and a 1-hour interval should be allowed between the 2 procedures. The findings also suggest that any factors that induce repeated or continuing bladder spasms may contribute to progressive dilatation of the upper urinary tract.

Contrast Media↗
PubMed1986

Initial bladder management in spinal cord injury: does it make a difference?

We classified 204 patients with acute spinal cord injury into 1 of 5 groups according to the initial form of urological management. Group A patients were placed on an intermittent catheterization program within 36 hours of injury, group B received a suprapubic trocar within 36 hours of injury, group C had urethral catheters in place for more than 36 hours before intermittent catheterization was begun, group D was on indwelling urethral catheter drainage throughout the hospitalization and discharged from the hospital with indwelling catheters, and group E was placed on intermittent catheterization in a community hospital. There were no statistically significant differences among the groups in the incidence of chills and fever, rate of urinary infections (excluding group D), incidence of upper tract changes, genitourinary complications or frequency of urological procedures at 1 year after injury. We conclude that the method of initial bladder management is relatively unimportant in determining the urological prognosis after spinal cord injury.

Adolescent↗
PubMed1986

Spinal cord injury associated with all-terrain vehicle accidents.

Five instances of three-wheeler, all-terrain vehicle accidents resulting in spinal cord injury are presented. Age range of victims was from 7 to 18 years. Of the five cases of spinal cord injury, three resulted in quadriplegia and two in paraplegia. Reports of all-terrain vehicle accidents in childhood from the US Consumer Product Safety Committee are also reviewed. Concerns are raised about the need for further data gathering about instances and types of injuries from these types of vehicles and the safety of use in all ages of children for these heavy, potentially high-speed vehicles.

Accidents↗
PubMed1985

The risk of bladder calculi in patients with spinal cord injuries.

A nonconcurrent prospective study of bladder calculi included 500 persons treated at the University of Alabama in Birmingham Spinal Cord Injury Care System between 1973 and 1981. Risk factors suspected of contributing to the development of bladder calculi were identified. Logistic regression analysis was used to estimate each risk factor's adjusted odds ratio and to develop a predictive model for bladder stone formation. Bladder calculi were most likely to develop within one year of injury. Patients developing bladder calculi prior to first definitive discharge were most likely to be white and have neurologically complete lesions and Klebsiella infections at admission. Patients developing bladder stones within two years of hospital discharge were most likely to be young and white and have indwelling urethral catheters and either Proteus or multiple-organism infections at discharge. The predictive model was 82% sensitive and 83% specific when applied to a validation sample of patients.

Adult↗
PubMed1985

Effective renal plasma flow: clinical significance after spinal cord injury.

We conducted a study to determine if effective renal plasma flow routinely measured by hippurate clearance during a comprehensive renal scintillation procedure is a relevant measure for assessing renal function in spinal cord injury patients. All subjects had spinal cord injury and had had contemporaneous comprehensive renal scintillation procedures and excretory urograms on 2 occasions 24 months or less apart. Each of the 469 kidneys was placed into 1 of 5 quintiles on the basis of its effective renal plasma flow at the first examination. The percentage of the kidneys that had clinically significant pyelocaliectasis or in which the pyelocaliectasis significantly worsened was 20.4 per cent in the lowest (first) quintile and 9.3, 2.2, 5.4 and 3.2 per cent in the second, third, fourth and fifth quintiles, respectively. Analogous data for ureterectasis were 16.1, 8.2, 2.2, 3.3 and 3.2 per cent. There was a significant (p less than 0.01) correlation between effective renal plasma flow and renal parenchymal thickness. Kidneys with renal calculi averaged effective renal plasma flows about 25 per cent lower than those of kidneys free of calculi. We conclude that effective renal plasma flow is a relevant measure for assessing renal function in spinal cord injury patients.

Acute Disease↗
PubMed1985

Spinal cord injury: its short-term impact on marital status.

We have had the impression that patients with spinal cord injury (SCI) experience fewer marriages and more divorces than their noninjured counterparts. To test this impression statistically, we examined the influence of SCI in association with other select variables on the marital status of 276 patients injured between 1973 and 1980 and treated at the University of Alabama in Birmingham Spinal Cord Injury Care System. The expected numbers of marriages and divorces in the study population were based on comparison with reported marriage and divorce rates for the general US population. Discriminant analysis was employed to identify variables associated significantly with a postinjury change in marital status. Substantially fewer marriages and more divorces occurred than were expected (p less than 0.05). No variables were associated significantly with marrying within three years of injury. However, divorcing patients were significantly more likely to be young black women who had been previously divorced, had no children, and had Barthel scores of less than 80. Using the most effective combination of these variables, 38.7% of the variance was explained, and the postinjury marital status of 81.5% of patients married at injury was predicted correctly. While other determinants of postinjury marital status undoubtedly exist, the likelihood of divorce can be assessed using a comparatively small set of predictor variables.

Adolescent↗
PubMed1985

Dependent variables in rehabilitation research.

It is important that rehabilitation professionals use appropriate techniques to evaluate their treatments. False, contradictory, diverse, and misleading interpretations can be obtained depending on how dependent variables in treatment outcome research are quantified. This report describes an evaluation of a single-subject investigation that used a push-up timer for teaching pressure relief maneuvers. Results are analyzed four separate ways, and can be taken to support three quite different conclusions. This illustrates that investigators should carefully select procedures of analysis before initiating a study to avoid having to make a post hoc and potentially biased selection of which mode(s) of data analysis and presentation is most appropriate. However, such an a priori selection of analysis does not relieve investigators of the responsibility for analyzing their data from different perspectives and discussing alternate or contradictory interpretations.

Adult↗
PubMed1984

Renal function after acute and chronic spinal cord injury.

Computer-assisted renal scintigraphy was performed on 160 acute and 240 chronic spinal cord injury patients, and 287 noninjured controls. Concurrently, measurements of global and individual kidney effective renal plasma flow, time of maximum activity in each kidney, ratio of maximum counts to the counts at 27 minutes after injection over each kidney and number of counts in each kidney at 1 to 2 minutes after injection were made. The time of peak activity over the kidney and differential function at 1 to 2 minutes after injection were not affected significantly by age, sex or spinal cord status. Global and individual effective renal plasma flows were significantly affected by all of these factors. Both plasma flow measures generally were higher for male than for female patients. Effective renal plasma flow decreased steadily after early adulthood and, except for the youngest and oldest patients, values were lower for spinal cord injury patients than for normal controls. The ratio of peak to 27-minute counts was affected significantly by age and spinal cord injury but not by sex. In patients without obvious pathological conditions followup scintigrams 1 to 3 years after injury showed no significant changes owing to interval since injury on any parameter studied. Lower limits of basal scintigraphic parameters are given for evaluation of renal status in neurologically intact or spinal cord injury persons.

Adolescent↗
PubMed1984

The risk of renal calculi in spinal cord injury patients.

A retrospective epidemiologic study of renal calculi was conducted on 5,915 patients from the National Spinal Cord Injury Data Research Center data base. Various risk factors suspected of contributing to the development of renal calculi were identified. Logistic regression analyses were conducted to estimate the adjusted odds ratio for the formation of renal calculi for each risk factor. Life-table techniques were used to assess the interval of highest renal stone risk after injury. Spinal cord injury patients in whom renal calculi developed were more likely to be male patients with neurologically complete lesions and histories of bladder stones. Renal stones were most likely to develop within 3 months after injury. The estimated cumulative proportion of patients free of renal stones 8 years after injury was 92 per cent. Although it appears that patients at high risk for renal calculi can be identified with a relatively small set of predictor variables, more definitive urological information is needed to improve predictive accuracy before final construction of mathematical predictive models that can be considered appropriate for use in a clinical environment.

Adult↗
PubMed1984

Serum creatinine as an indicator of renal function after spinal cord injury.

This study was conducted to determine (1) if serum creatinine levels (SCL) in spinal cord injury (SCI) patients are influenced by neurologic level of lesion, sex, age, or time since injury, and (2) if SC values are a sensitive indicator of renal function (as reflected by renal plasma flow [RPF]) in these patients. The overall SC mean and SD were 0.9 +/- 0.2mg/dl (n = 141). There was no difference in SC values between patients with higher injuries (T-6 or above) and patients with lower injuries (T-7 or below), nor was there any difference between patients with lesions less than 3 months, 10-14, 22-26, 34-38, 46-50, or 58-62 months in duration. Age and gender each accounted for less than 5% of the variation in SC. There was no significant correlation between RPF and SC (unless the patient also had moderate or severe pyelocaliectasis) nor between change in serum RPF (from the previous examination, usually 12 months earlier) and change in SC, suggesting that SCL does not reflect the functional status of the kidney in these patients.

Adolescent↗