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Bladder Cancer after Spinal Cord Injury: Mortality Risk
PM&R
Participants: Screening data from 26 individuals with MISCI enrolled in a randomized clinical trial. Interventions: Screening data from 26 individuals with MISCI enrolled in a randomized controlled trial were analyzed utilizing multiple regression to determine if baseline VO2max values obtained using a metabolic cart during arm cycle ergometry could be predicted from other baseline screening information. Main Outcome Measures: Of the available baseline data we hypothesized that Physical Activity Scale for Individuals with Disability (PASID), body mass index (BMI), Lower Extremity Motor Score (LEMS), time since injury, age and lesion level would contribute most to predicting VO2max, and entered these factors into the regression. Results or Clinical Course: The best-fit multiple regression model predicting VO2max included PASID and BMI (F¼9.243; p¼0.000), and accounted for 60% of the variance. Controlling for LEMS, age and level of lesion created no difference in PASID and BMI influence on the model. Conclusions: Two easily obtained clinicial data sources, PASID and BMI, partially predicted (60%) VO2max in adults with MISCI providing useful information in clinical and community settings without access to computerized metabolic analysis in order to individualize safe activity levels. Poster 302 Bladder Cancer after Spinal Cord Injury: Mortality Risk. Laura Nahm, MD (Stanford University, Redwood City, CA, United States); Yuying Chen, MD PhD; Michael J. DeVivo, DrPH; Keith Lloyd, MD. Disclosures: L. Nahm, No Disclosures: I Have Nothing To Disclose. Objective: To confirm and provide a more precise estimate of increased bladder cancer mortality in persons with spinal cord injury (SCI), as compared to the general United States (U.S.) population, after adjusting for age, gender, and race. Design: Cohort study. Setting: SCI Model Systems and Shriner’s Hospitals SCI units throughout the U.S. Participants: Persons with traumatic SCI injured since 1936 and treated at a model system or Shriners hospital Interventions: NA Main Outcome Measures: Standardized mortality ratio (SMR). Results or Clinical Course: Of a total of 10,577 deaths over 543,348 person-years of follow-up, 94 deaths (0.89%) were known to be caused by bladder cancer. The expected number of deaths from bladder cancer would have been 14.8 if persons with SCI had the same bladder cancer mortality as the general population; thus the overall SMR is calculated to be 6.4 (95% CI 5.1-7.8). Increased mortality risk from bladder cancer was observed for those of age 30-59 years (SMR 19.3), both females (SMR 11.6) and males (SMR 5.7), persons injured 10 or more years ago (SMR 8.7), and motor complete injuries (SMR 6, 14.3, and 12.1 for C1-C4, C5-C8, and T1-S5 injuries, respectively). Bladder cancer mortality was not significantly increased for ventilator users, those with motor incomplete injuries of any level, or those injured less than 10 years. Conclusions: Our study findings confirm the overall increased mortality risk from bladder cancer in persons with SCI using a large SCI cohort.
Vol. 5, Iss. 9S, 2013
S131
Friday, October 4, 2013 2:30 PM-4:00 PM Potomac C
414. PEDIATRIC RESEARCH AND CLINICAL PEARLS Poster 138 Increased Incidence of Chiari 1 Malformation in Children with Transverse Myelitis. Sathya Vadivelu, DO (Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD, United States); Sudhakar Vadivelu, DO; Maureen A. Mealy, RN, BSN, MSCN; Daniel Becker, MD. Disclosures: S. Vadivelu, No Disclosures: I Have Nothing To Disclose. Objective: To assess Chiari malformation (CM) in the pediatric transverse myelitis (TM) population Design: Retrospective review. Setting: Pediatric Subspecialty Clinics. Participants: 65 cases of TM patients under 21 years old (yo) between 2006 and 2013. Interventions: Not applicable. Main Outcome Measures: We examined radiographic evidence of CM based on MRI report. We reviewed demographic characteristics, radiographic findings, presenting symptoms, and long term outcomes reported based on chart review. Results or Clinical Course: We identified 65 cases of TM presenting under 21 yo. Within those cases, there were 7 cases of CM. Of the 7 cases of CM, all presented with TM under 18 months of age, and all presented with TM affecting the cervical spinal cord. CM was an incidental finding on initial evaluation for TM in 4 of the 7 cases reviewed. In 3 of the 7 cases, the CM developed 15 months to 6 years after the onset of TM. Discussion: To our knowledge, this is the first report identifying a higher incidence of CM in children with TM compared to the general pediatric population and to outline the natural history of CM in the TM population. Given the incidence of CM in children presenting with TM at a very young age, one might speculate a potential mechanical or vascular component contributing to the development of the acute myelopathy. Conclusions: In our study approximately 1 in 10 children with TM had CM as compared to the general population of 1 in 1001000. All children with CM in our study were younger than 18 months when presenting with TM, and all cases of TM demonstrated cervical level involvement. These findings may impact clinical management of CM. However, larger prospective clinical trials are needed to further investigate this finding and propose potential early surgical interventions. Poster 139 Clinical Use of the Intelligent Stretcher: Comparison with Research Setting Results in a Retrospective and Prospective Chart Review. La Shawna Williams (Rehabilitation Institute of Chicago, Chicago, IL, United States); Theresa Clancy, PT; Tara Egan, PT; Theresa Sukal-Moulton, DPT, PhD; Liqun Zhang, PhD; Kai Chen, PhD; Deborah J. Gaebler-Spira, MD.
Participants: Screening data from 26 individuals with MISCI enrolled in a randomized clinical trial. Interventions: Screening data from 26 individuals with MISCI enrolled in a randomized controlled trial were analyzed utilizing multiple regression to determine if baseline VO2max values obtained using a metabolic cart during arm cycle ergometry could be predicted from other baseline screening information. Main Outcome Measures: Of the available baseline data we hypothesized that Physical Activity Scale for Individuals with Disability (PASID), body mass index (BMI), Lower Extremity Motor Score (LEMS), time since injury, age and lesion level would contribute most to predicting VO2max, and entered these factors into the regression. Results or Clinical Course: The best-fit multiple regression model predicting VO2max included PASID and BMI (F¼9.243; p¼0.000), and accounted for 60% of the variance. Controlling for LEMS, age and level of lesion created no difference in PASID and BMI influence on the model. Conclusions: Two easily obtained clinicial data sources, PASID and BMI, partially predicted (60%) VO2max in adults with MISCI providing useful information in clinical and community settings without access to computerized metabolic analysis in order to individualize safe activity levels. Poster 302 Bladder Cancer after Spinal Cord Injury: Mortality Risk. Laura Nahm, MD (Stanford University, Redwood City, CA, United States); Yuying Chen, MD PhD; Michael J. DeVivo, DrPH; Keith Lloyd, MD. Disclosures: L. Nahm, No Disclosures: I Have Nothing To Disclose. Objective: To confirm and provide a more precise estimate of increased bladder cancer mortality in persons with spinal cord injury (SCI), as compared to the general United States (U.S.) population, after adjusting for age, gender, and race. Design: Cohort study. Setting: SCI Model Systems and Shriner’s Hospitals SCI units throughout the U.S. Participants: Persons with traumatic SCI injured since 1936 and treated at a model system or Shriners hospital Interventions: NA Main Outcome Measures: Standardized mortality ratio (SMR). Results or Clinical Course: Of a total of 10,577 deaths over 543,348 person-years of follow-up, 94 deaths (0.89%) were known to be caused by bladder cancer. The expected number of deaths from bladder cancer would have been 14.8 if persons with SCI had the same bladder cancer mortality as the general population; thus the overall SMR is calculated to be 6.4 (95% CI 5.1-7.8). Increased mortality risk from bladder cancer was observed for those of age 30-59 years (SMR 19.3), both females (SMR 11.6) and males (SMR 5.7), persons injured 10 or more years ago (SMR 8.7), and motor complete injuries (SMR 6, 14.3, and 12.1 for C1-C4, C5-C8, and T1-S5 injuries, respectively). Bladder cancer mortality was not significantly increased for ventilator users, those with motor incomplete injuries of any level, or those injured less than 10 years. Conclusions: Our study findings confirm the overall increased mortality risk from bladder cancer in persons with SCI using a large SCI cohort.
Vol. 5, Iss. 9S, 2013
S131
Friday, October 4, 2013 2:30 PM-4:00 PM Potomac C
414. PEDIATRIC RESEARCH AND CLINICAL PEARLS Poster 138 Increased Incidence of Chiari 1 Malformation in Children with Transverse Myelitis. Sathya Vadivelu, DO (Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD, United States); Sudhakar Vadivelu, DO; Maureen A. Mealy, RN, BSN, MSCN; Daniel Becker, MD. Disclosures: S. Vadivelu, No Disclosures: I Have Nothing To Disclose. Objective: To assess Chiari malformation (CM) in the pediatric transverse myelitis (TM) population Design: Retrospective review. Setting: Pediatric Subspecialty Clinics. Participants: 65 cases of TM patients under 21 years old (yo) between 2006 and 2013. Interventions: Not applicable. Main Outcome Measures: We examined radiographic evidence of CM based on MRI report. We reviewed demographic characteristics, radiographic findings, presenting symptoms, and long term outcomes reported based on chart review. Results or Clinical Course: We identified 65 cases of TM presenting under 21 yo. Within those cases, there were 7 cases of CM. Of the 7 cases of CM, all presented with TM under 18 months of age, and all presented with TM affecting the cervical spinal cord. CM was an incidental finding on initial evaluation for TM in 4 of the 7 cases reviewed. In 3 of the 7 cases, the CM developed 15 months to 6 years after the onset of TM. Discussion: To our knowledge, this is the first report identifying a higher incidence of CM in children with TM compared to the general pediatric population and to outline the natural history of CM in the TM population. Given the incidence of CM in children presenting with TM at a very young age, one might speculate a potential mechanical or vascular component contributing to the development of the acute myelopathy. Conclusions: In our study approximately 1 in 10 children with TM had CM as compared to the general population of 1 in 1001000. All children with CM in our study were younger than 18 months when presenting with TM, and all cases of TM demonstrated cervical level involvement. These findings may impact clinical management of CM. However, larger prospective clinical trials are needed to further investigate this finding and propose potential early surgical interventions. Poster 139 Clinical Use of the Intelligent Stretcher: Comparison with Research Setting Results in a Retrospective and Prospective Chart Review. La Shawna Williams (Rehabilitation Institute of Chicago, Chicago, IL, United States); Theresa Clancy, PT; Tara Egan, PT; Theresa Sukal-Moulton, DPT, PhD; Liqun Zhang, PhD; Kai Chen, PhD; Deborah J. Gaebler-Spira, MD.