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Neurogenic shock (NS) is a distributive type of shock resulting in hypotension, classically with bradycardia, that is attributed to the disruption of the autonomic pathways within the spinal cord.1 Despite the potential for a devastating outcome, our current understanding of the incidence, patterns, and outcomes associated with NS, and their implications is poorly understood. We, therefore, reviewed our experience to determine the incidence and outcomes of NS after traumatic spinal cord injury (SCI).
After Institutional Review Board approval, a retrospective review of the trauma registry at the Los Angeles County + University of Southern California (LAC + USC) Medical Center, a Level I trauma center, was performed. All patients who sustained SCI at our institution during a 4-year period (January 2006 to December 2009) were identified and their medical records reviewed. Patients with obvious hemorrhagic shock were excluded from analysis. NS was defined as hypotension (systolic blood pressure less than 100mmHg) or the classic presentation of hypotension and bradycardia (heart rate less than 80 beats per minute). Demographics, clinical data, and outcomes were compared between those who developed NS and those who did not.
A total of 180 patients sustained a SCI (41 cervical, 73 thoracic, 48 lumbar, and 18 multiple levels). Of those, 16 (8.8%) developed NS: five had C1-C4 SCI, five C5-C7, four thoracic (1 had T1 SCI, 2 had T4, and 1 had T10), zero lumbar, and two had SCI at multiple levels (Fig. 1). Both patients with developed NS after multiple-level injury had associated SCI at the level of the cervical spine (C6-C7/T10-L1 and C7-T1/T4).
Patients who developed NS were predominantly male (75.0 vs 84.7%, P = 0.299), had a higher mean age (54.3 ± 19.3 vs 35.2 ± 16.0 years, P4 0.003), and were more likely...