Bladder Management of Traumatic Spinal Cord Injury in the Acute Trauma Setting

Purpose: Neurogenic bladder is a common complication of spinal cord Injury (SCI). This condition increases the risk of urinary tract infection, bladder stones, urinary incontinence, and renal failure. Immediately following SCI, patients are often medically stabilized with an indwelling catheter (IC) in place. If possible, efforts are made to transition from IC to Clean Intermittent Catheterization (CIC), which has been shown to have less risk of complications. Currently, no protocol exists for transition from IC to CIC due to research gaps in spinal cord injury rehabilitation. The purpose of this project is to describe the bladder management of newly diagnosed SCI patients in the acute trauma setting and to analyze factors related to their demographics, injury, and hospital course. Methods: Electronic medical records of patients admitted to Baylor University Medical Center (BUMC) followed by inpatient rehabilitation at Baylor Institute for Rehabilitation (BIR) in Dallas, TX were reviewed. A total of 59 patients met the following criteria: initial presentation and management of SCI at BUMC, immediate inpatient rehabilitation at BIR, traumatic SCI AIS A-E. Results: The age at time of injury was between 16-88 years of age with a mean of 45 (s.d. ± 22.5). The average length of stay at BUMC was between 4 to 66 days with a mean of 20 (s.d. ± 16.5). The most common mechanisms of injury were fall in 27 patients (45%), gun shot wound in 16 patients (27%), and motor vehicle collision in 10 patients (17%). A total of 54 patients (92%) had an IC placed at admission to BUMC. Bladder management at BUMC discharge was as follows: IC 24 (41%), CIC 16 (27%), and volitional voiding 19 (32%). Of the 54 patients, 24 patients (44%) had the IC removed before discharge, while 30 (56%) were discharged and admitted to BIR with IC. An IC was in place between 0 and 39 days with a mean of 9 (s.d. ± 9.6). Urinary tract infection (UTI) developed in 11 (19%) patients at BUMC. Conclusions: Over ninety percent of patients had an IC placed immediately following SCI. Of the patients that could not tolerate volitional voiding, 40% achieved the optimal method of CIC by the time of discharge from BUMC. This study describes the current clinical management of the bladder in SCI, and demonstrates that UTI was observed in 19% of patients. Further research is warranted to analyze additional factors related to complications from neurogenic bladder in SCI rehabilitation.