Assessing the correlation of trauma severity, blood sugar level, and neurologic outcomes in traumatic spinal cord injury patients

Abstract

Introduction: Trauma, due to stimulating stress responses like hormones, leads to increased blood sugar level (BS level), which worsens cerebrospinal and renal damages. Admission hyperglycemia associated with poor outcomes in severe traumatic injuries, therefore glucose control leads to improved outcomes and better prognosis of these patients. This study aims to analyze the impact of severity of spinal cord injury (SCI) (based on Frankel classification) on BS level in these patients. Furthermore, the effect of controlling the BS level in a normal range on improving the neurological outcomes [muscular force (MF)] was examined. Methods: This is a cross-sectional study in which admission BS level of all SCI patient, were measured, and regular treatments were applied based on standard protocols. The recovery process of motor and sensory disorders was also examined in discharge and was evaluated with the primarily measured BS level. Besides, patients with high BS level (more than 200 mg/dl) underwent the insulin protocol, and the effects of glucose level control on the final outcome of SCI patients were evaluated. Results: Among the 380 patients enrolled in this study, 266 were male (70%) and 114 were female (30%). The mean age of patients was 35.84 ± 18-65 years old. The mean hospital length of stay was 5.98 days (from 3 to 14 days). The mean BS level in patients with MF of 0/5, 1/5, 2/5, 3/5, 4/5 and 5/5 were 169.8, 185.9, 177.3, 172.8, 117.5 and 118.0 mg/dl, respectively. The rate of MF changes was measured in hyperglycemic patients who underwent an insulin protocol. Conclusion: As the SCI trauma becomes more severe, the BS level increases with a higher rate. Besides, there was a significant difference (P = 0.001) in MF of patients before and after the insulin protocol prescription.

Keywords: Trauma, Spinal Cord Injury, Blood Sugar Level, Insulin