Article

A retrospective, multicenter study. OBJECTIVES: To investigate the
relationship between bowel and bladder management methods and symptomatic
autonomic dysreflexia (AD) during hospitalization in patients with spinal cord
injury (SCI). SETTING: Twenty-eight Rosai hospitals in Japan. METHODS: The study
subjects were 571 patients with SCI who had been admitted to 28 Rosai hospitals
between April 1997 and March 2007 for rehabilitation therapy and fulfilled the
following criteria: (1) SCI at or above sixth thoracic level, (2) discharged from
hospital after more than 4 months of admission for initial injury and (3) lack of
pressure ulcers, deep venous thrombosis, ureteral and renal stones or heterotopic
ossification throughout hospitalization to exclude possible influence of these
complications on cardiovascular reflexes. The study subjects were examined for
the incidence of symptomatic AD according to age, sex, ASIA Impairment Scale,
injury level, bowel and bladder management techniques at discharge. RESULTS: The
Rosai Hospital registry included 3006 persons with SCI during 1997-2007, and 571
patients fulfilled the above criteria. The highest incidence of symptomatic AD
was diagnosed in subjects using reflex voiding and in those using manual removal
of stool. By contrast, the lowest incidence of symptomatic AD was in those on
continent spontaneous voiding and continent spontaneous defecation. CONCLUSION:
Medical staff should evaluate the presence of AD in patients with SCI at or above
the T6 level under bladder and bowel management such as reflex voiding and manual
removal of stool.

Langue : ANGLAIS