Accepted for/Published in: JMIR Research Protocols
Date Submitted: Sep 27, 2023
Date Accepted: Mar 10, 2025
Development of a Risk Score to Aid in the Diagnosis of Infections after Spinal Cord Injury: Protocol for A Retrospective Cohort Study
ABSTRACT
Background:
Spinal cord injury (SCI) patients who develop urinary tract infection (UTI) present differently in SCI patients than non-SCI population. UTIs can cause loss of quality of life, and even lead to life-threatening complications including urosepsis. One of the biggest challenges in SCI management is distinguishing symptomatic urinary tract infection (UTI) from asymptomatic bacteriuria (ASB), which is also high in SCI patients, and there is a lack of standardization.
Objective:
This study aims to: #1) Create baseline physiological vital signs and lab values for SCI patients and controls. #2) Determine positive predictive values of physiologic measures for UTI to inform a risk score in SCI patients, allowing improvement of UTI diagnosis accuracy in SCI patients and prevention of overuse of antibiotics.
Methods:
#1) This retrospective cohort data is collected from national Veterans Health Administration data and used to establish physiologic baseline for vital sign and lab measurements after SCI. #2) A validated case classification algorithm will help classify ASB, UTI or indeterminate and determine positive predictive values for vital sign and lab thresholds for UTI after SCI.
Results:
Currently our anticipated results include SCI patients having lower blood pressure, temperature, hemoglobin, and higher white blood cell count versus control. However, mean serum white blood count, glucose, and urine white blood cells are expected to be higher in the SCI cases as compared to non-SCI controls. Additionally, vital signs and lab value variabilities will likely have high positive predictive value for UTI.
Conclusions:
In order to figure out differences in vital signs between SCI patients and controls, this study aims to establish a baseline physiology vitals in SCI patients and then also calculate vital signs and lab thresholds for UTI for SCI patients. It is vital that we establish the thresholds for UTI diagnosis in SCI patients as they differ from controls and UTIs can have severe complications in SCI patients.
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