Abstract
Study design
Retrospective study
Objectives
To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections.
Setting
One university hospital and two SCI centres in Switzerland.
Methods
Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation.
Results
Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52–73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15–35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8–27), and for those older than 60 years with a median of 34 days (IQR 17–39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia.
Conclusions
Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 1 print issues and online access
We are sorry, but there is no personal subscription option available for your country.
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Data availability
All data supporting the findings of this study are available within the article and its Supplementary Materials
References
Anderegg N, Panczak R, Egger M, Low N, Riou J. Survival among people hospitalized with COVID-19 in Switzerland: a nationwide population-based analysis. BMC Med. 2022;20:164.
Ochani R, Asad A, Yasmin F, Shaikh S, Khalid H, Batra S, et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021;29:20–36.
Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, B Pearson CA, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020;18:270.
O’Connell CM, Eriks-Hoogland I, Middleton JW. Now, more than ever, our community is needed: spinal cord injury care during a global pandemic. Spinal Cord Ser Cases. 2020;6:18.
López-Dolado E, Gil-Agudo A. Lessons learned from the coronavirus disease 2019 (Covid-19) outbreak in a monographic center for spinal cord injury. Spinal cord. 2020;58:517–9.
Righi G, Del Popolo G. COVID-19 tsunami: the first case of a spinal cord injury patient in Italy. Spinal Cord Ser Cases. 2020;6:22.
Korupolu R, Stampas A, Gibbons C, Hernandez Jimenez I, Skelton F, Verduzco-Gutierrez M. COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury. Spinal Cord Ser Cases. 2020;6:35.
Dicks MA, Clements ND, Gibbons CR, Verduzco-Gutierrez M, Trbovich M. Atypical presentation of Covid-19 in persons with spinal cord injury. Spinal Cord Ser Cases. 2020;6:38.
Brommer B, Engel O, Kopp MA, Watzlawick R, Muller S, Pruss H, et al. Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level. Brain. 2016;139:692–707.
Bauman WA, Spungen AM, Raza M, Rothstein J, Zhang RL, Zhong YG, et al. Coronary artery disease: metabolic risk factors and latent disease in individuals with paraplegia. Mt Sinai J Med. 1992;59:163–8.
Nash MS, Tractenberg RE, Mendez AJ, David M, Ljungberg IH, Tinsley EA, et al. Cardiometabolic Syndrome in People With Spinal Cord Injury/Disease: Guideline-Derived and Nonguideline Risk Components in a Pooled Sample. Arch Phys Med Rehabil. 2016;97:1696–705.
Duckworth WC, Solomon SS, Jallepalli P, Heckemeyer C, Finnern J, Powers A. Glucose intolerance due to insulin resistance in patients with spinal cord injuries. Diabetes. 1980;29:906–10.
Henzel MK, Shultz JM, Dyson-Hudson TA, Svircev JN, DiMarco AF, Gater DR Jr. Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era. J Am Coll Emerg Physicians Open. 2020;1:1404–12.
DeVivo MJ, Biering-Sorensen F, New P, Chen Y, International Spinal Cord Injury Data S. Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal cord. 2011;49:596–9.
Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, et al. International standards for neurological classification of spinal cord injury: cases with classification challenges. Top Spinal Cord Inj Rehabil. 2014;20:81–9.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7:357–63.
Rodríguez-Cola M, Jiménez-Velasco I, Gutiérrez-Henares F, López-Dolado E, Gambarrutta-Malfatti C, Vargas-Baquero E, et al. Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury. Spinal Cord Ser Cases. 2020;6:39.
Barman A, Roy SS, Sasidharan SK, Sahoo J. Clinical features and prognosis of COVID-19/SARS-CoV-2 infections in persons with spinal cord injury: a review of current literature. Spinal Cord Ser Cases. 2021;7:58.
Stillman MD, Capron M, Alexander M, Di Giusto ML, Scivoletto G. COVID-19 and spinal cord injury and disease: results of an international survey. Spinal Cord Ser Cases. 2020;6:21.
Gustafson K, Stillman M, Capron M, O’Connell C, Longoni Di Giusto M, Tyagi N, et al. COVID-19 and spinal cord injury and disease: results of an international survey as the pandemic progresses. Spinal Cord Ser Cases. 2021;7:13.
Galea MD, Gelman MA, Galea VP, Raulkar KP, Kornfeld S, Johnson-Kunjukutty S, et al. COVID-19 in spinal cord injury patients at a veterans administration hospital: A case series. J Spinal Cord Med. 2022;45:668–80.
Burns SP, Eberhart AC, Sippel JL, Wilson GM, Evans CT. Case-fatality with coronavirus disease 2019 (COVID-19) in United States Veterans with spinal cord injuries and disorders. Spinal Cord. 2020;58:1040–104.
Berlly M, Shem K. Respiratory management during the first five days after spinal cord injury. J Spinal Cord Med. 2007;30:309–18.
Galeiras Vázquez R, Rascado Sedes P, Mourelo Fariña M, Montoto Marqués A, Ferreiro Velasco ME. Respiratory management in the patient with spinal cord injury. BioMed Res Int. 2013;2013:168757.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–4.
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345–55.
Author information
Authors and Affiliations
Contributions
IEH proposed the study, and MB, LM, and IEH accomplished its design, conceptualisation and implementation. Study data were collected by MB and LM. Statistical analysis was performed by LM and MB. LM, MB and IEH examined and interpreted the data. The manuscript was drafted by MB with support of LM, and IEH. All authors provided critical feedback on the manuscript regarding important intellectual content, and provided their approval on the final version.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval
The study was formally approved by regional medical ethics committee of northwest and central Switzerland (Project-ID 2021-01904). All the participants included in the study consented to anonymized use of data for research purposes and had the option to opt out.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Eriks-Hoogland, I.E., Barth, M.A., Müller, L.L. et al. COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised. Spinal Cord Ser Cases 10, 5 (2024). https://doi.org/10.1038/s41394-024-00617-6
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41394-024-00617-6