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Spinal Cord Injury Risk Assessment for Thromboembolism (SPIRATE Study)

Green, David MD, PhD; Hartwig, Diane CNP; Chen, David MD; Soltysik, Robert C. MS; Yarnold, Paul R. PhD

American Journal of Physical Medicine & Rehabilitation: December 2003 - Volume 82 - Issue 12 - p 950-956
doi: 10.1097/01.PHM.0000098043.88979.BA
Research Article: Spinal Cord Injury

Green D, Hartwig D, Chen D, Soltysik RC, Yarnold PR: Spinal Cord Injury Risk Assessment for Thromboembolism (SPIRATE study). Am J Phys Med Rehabil 2003;82:950–956.

Objective To identify risk factors for venous thromboembolism (VTE) during the rehabilitation phase of spinal cord injury.

Design A comprehensive review of the charts of all patients admitted between 1992 and 1995 for rehabilitation after spinal cord injury. Only records including evidence for objective testing for thromboembolism were included. The analysis variables included type and location of spinal cord injury, American Spinal Injury Association classification, concomitant injuries, surgical procedures, complications, preexisting illnesses, and use of antithrombotic prophylaxis. Hierarchically optimal classification tree analysis was employed to develop a nonlinear model for predicting deep vein thrombosis.

Results The analysis sample consisted of these 243 persons with acute spinal cord injury, 51 of whom had venous thromboembolism, and eight of whom died. A three-variable model emerged that identified patient groups differing in relative likelihood of experiencing deep vein thrombosis. The highest likelihood group were patients with cancer over the age of 35 yrs. Women between the ages of 36 and 58 yrs without cancer were also at increased risk, as were cancer-free men with flaccid paralysis.

Conclusions Venous thromboembolism is more likely to develop in spinal cord injury patients who are older, obese, and have flaccid paralysis or cancer. These patients should receive vigorous prophylaxis against venous thromboembolism.

From the Departments of Medicine and Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, the Rehabilitation Institute of Chicago, Chicago, Illinois.

Supported by grant H133G990046 from the National Institute on Disability and Rehabilitation Research.

All correspondence should be addressed to David Green, MD, PhD, Rehabilitation Institute of Chicago, 345 East Superior Street, Room 1407, Chicago, IL 60611.

© 2003 Lippincott Williams & Wilkins, Inc.