Subjects
Study population
This study is a retrospective cohort analysis conducted at a single center, utilizing data from 195 consecutive cases of spinal cord injury (SCI) admitted to Huzhou First People’s Hospital in Huzhou City, Zhejiang Province, China, during the period from January 2023 to December 2024.
Inclusion criteria
This study was approved by the hospital ethics committee (approval number: 2022GZB05). All cases that satisfied the inclusion criteria throughout the study period were incorporated through a method of consecutive sampling. The inclusion criteria were as follows: (1)The evaluation of spinal cord injury severity is exclusively grounded in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), which were updated by the American Spinal Cord Injury Association (ASIA) in 2019.(2) Age > 18 years; (3) Completed assessment of the Post-Traumatic Stress Disorder Self-Rating Scale (PTSD-SS), which has good reliability (Cronbach’s α = 0.92, split-half reliability = 0.95, and retest reliability = 0.87) [11, 12]; (4) No history of psychiatric disorders and no communication barriers; (5) Clinical data were complete (including: ① ASIA ISNCSCI assessment within 24 h of admission; ② MRI/CT of the spine (injury segments/grading); ③ weekly dynamic records of MBI and ASIA grading during the hospitalization period; and ④ PTSD-SS assessment 72 h before discharge).
Exclusion criteria
Patients meeting any of the following criteria were excluded: (1) History of SCI or related surgical procedures; (2) Coagulation disorders or infectious diseases; (3) Major life events within the past six months (e.g., bereavement, divorce, or natural disasters); (4) Psychiatric disorders, mental illness or relevant medical history; (5)Severe cardiovascular or cerebrovascular diseases, malignancies, or other serious conditions; (6) Neurological diseases unrelated to SCI, such as stroke, Parkinson’s disease, or Guillain-Barré syndrome; (7) Critically ill patients or those with excessive emotional distress preventing PTSD assessment.
Data collection
General patient information was collected, including age, sex, marital status, personal income level, and educational background. Clinical data included injury-related factors (cause of injury, severity of spinal cord injury, and estimated rehabilitation outcome) and complications (number of complications, pulmonary and urinary tract infections, pressure ulcers, deep vein thrombosis, autonomic nervous system dysfunction, and psychological disorders). The degree of spinal cord nerve injury is consistent with the American Spinal Cord Injury Association (ASIA) classification of injury. The PTSD Self-Rating Scale (PTSD-SS) consists of 24 items assessing five dimensions: subjective evaluation of the traumatic event, recurrent intrusive experiences, avoidance symptoms, heightened arousal, and impaired social functioning. Scores range from 24 to 120, with a total score of ≥ 50 indicating PTSD. Scores between 50 and 59 suggest mild PTSD, while scores of ≥ 60 indicate moderate to severe PTSD. PTSD incidence was analyzed, and patients were categorized into PTSD and non-PTSD groups accordingly.
Observational indicators
Differences in demographic characteristics, including age, sex, marital status, personal income level, and educational background, were analyzed between the PTSD and non-PTSD groups. Clinical factors, such as cause of injury, severity of spinal cord injury, expected rehabilitation outcomes, and complications, including the number of complications, pulmonary and urinary tract infections, pressure ulcers, deep vein thrombosis, autonomic nervous system dysfunction, and psychological disorders, were also compared. Factors showing significant differences were further analyzed using multivariate logistic regression.
Statistical analysis
Statistical analysis was performed using SPSS 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Categorical variables, including demographic characteristics, injury-related factors, and complications, were expressed as percentages (%). The chi-square test was used to identify factors with statistically significant differences, which were subsequently analyzed using multivariate logistic regression.