Spinal Cord Injuries Clinical Trial
Official title:
Hemodynamic Management Following Acute Traumatic Spinal Cord Injury: A Randomized, Controlled Trial
The purpose of this study is to assess the effect of various hemodynamic management strategies on functional neurologic outcomes and non-neurologic adverse events in the first 5 days following acute spinal cord injury (SCI). The hemodynamic management strategies assessed include targeting a mean arterial blood pressure (MAP) goal of 85-90 mmHg, targeting a spinal cord perfusion pressure (SCPP) goal of ≥65 mmHg, or targeting normal hemodynamics, which is a MAP goal of ≥65 mmHg.
Status | Not yet recruiting |
Enrollment | 228 |
Est. completion date | July 31, 2026 |
Est. primary completion date | September 15, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Traumatic spinal cord injury Exclusion Criteria: - Patients with an injury from a trauma that penetrates the spinal cord (i.e., gunshot or knife wound resulting in cord transection) - Preexisting neurologic or spinal cord injury - Severe traumatic brain injury as measured by a best resuscitated Glasgow Coma Scale (GCS) score of <8 at 24 hours following injury - Presence of traumatic injuries that preclude spine surgery within 24 hours of presentation - Concomitant injury/illness requiring targeted blood pressure management (e.g., injury to the aorta, aortic dissection, hemorrhagic stroke) - Preexisting history of neuromotor disorders (i.e., cerebral palsy, Parkinson disease, etc.) - Not expected to survive >24h - Cord transection identified by radiologist and agreed upon by the spine surgery team - Injury below spinal cord level L1 - Prisoners - Pregnant women |
Country | Name | City | State |
---|---|---|---|
United States | The University of Texas Health Science Center at Houston | Houston | Texas |
Lead Sponsor | Collaborator |
---|---|
The University of Texas Health Science Center, Houston | Trauma Research and Combat Casualty Care Collaborative (TRC4) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | The severity of a spinal cord injury (SCI) as assessed by the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSC) motor score | Upper and lower extremities will be assessed, and motor strength at each spinal cord level will be scored from 0 to 5 (0 indicates total paralysis and 5 indicates active movement against full resistance), with a maximum score of 25 for each extremity, totaling 100 for all four extremities. Total score ranges from 0 to 100, with a higher score indicating a better outcome. | 6 weeks following injury | |
Primary | Performance in activities of daily living and mobility as assessed by the Spinal Cord Independence Measure (SCIM) III score | There are 3 subscales on the SCIM III: self-care (4 items, score ranging from 0-20), respiration and sphincter management (4 items, score ranging from 0-40), and mobility (9 items, score ranging from 0-40). Total score ranges from 0 to 100, with a higher score indicating a better outcome. | 6 weeks following injury | |
Secondary | Change in motor function as assessed by the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSC) motor score | Upper and lower extremities will be assessed, and motor strength at each spinal cord level will be scored from 0 to 5 (0 indicates total paralysis and 5 indicates active movement against full resistance), with a maximum score of 25 for each extremity, totaling 100 for all four extremities. Total score ranges from 0 to 100, with a higher score indicating a better outcome. | 6 months following injury, 12 months following injury | |
Secondary | Change in sensory function as assessed by the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSC) sensory score | For each side of the body, 28 key sensory points will be assessed by light touch, and each area will be scored from 0 to 2 (0 indicates sensing is absent, 1 indicates sensing is altered, and 2 indicates that sensing is normal). Additionally, for each side of the body 28 key sensory points will be also be assessed by pin prick, and each area will be scored from 0 to 2 (0 indicates sensing is absent, 1 indicates sensing is altered, and 2 indicates that sensing is normal). Scores for light touch and pin prick assessments for both sides of the body will be combined, and the total score ranges from 0 to 224, with a higher score indicating a better outcome. | 6 months following injury, 12 months following injury | |
Secondary | Change in performance in activities of daily living and mobility as assessed by the Spinal Cord Independence Measure (SCIM) III score | There are 3 subscales on the SCIM III: self-care (4 items, score ranging from 0-20), respiration and sphincter management (4 items, score ranging from 0-40), and mobility (9 items, score ranging from 0-40). Total score ranges from 0 to 100, with a higher score indicating a better outcome. | 6 months following injury, 12 months following injury | |
Secondary | Number of ICU-free days | Number of ICU-free days = [30 days - ICU length of stay in days]. Patients with ICU length of stay >30 days will be assigned a value of zero ICU-free days. | 30 days from baseline | |
Secondary | Duration of time (hours) receiving goal caloric requirements by enteric nutrition | first 5 days of hospitalization | ||
Secondary | Number of participants developing a central line-associated blood stream infection | Blood stream infection is defined as bacteremia confirmed by blood culture in the presence of a central venous catheter. | Baseline to hospital discharge or 30 days, whichever comes first | |
Secondary | Number of participants developing a pneumothorax from central venous catheter insertion | Baseline to hospital discharge or 30 days, whichever comes first | ||
Secondary | Number of participants developing pneumonia | Pneumonia is defined as 10,000 colony forming units (cfu)/milliliter (mL) on bronchioalveolar lavage or mini bronchioalveolar lavage, or clinical diagnosis of pneumonia with subsequent antibiotic treatment. | Baseline to hospital discharge or 30 days, whichever comes first | |
Secondary | Number of participants developing acute kidney injury using the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria | Acute kidney injury using the RIFLE criteria is defined as a 50% increase in serum creatinine from baseline or urine output <0.5 mL/h for 6 hours. | Baseline to hospital discharge or 30 days, whichever comes first | |
Secondary | Number of deaths | Baseline to hospital discharge or 30 days, whichever comes first |
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