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Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a
Steven C Kirshblum1, Jamie G House, Kevin C O'connor
1Spinal Cord Injury and Ventilator Dependent Program, Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA. skirshblum@kessler-rehab.com
Objective:
To determine the existence and frequency of silent autonomic dysreflexia in subjects with a complete spinal cord injury (SCI) above the neurologic level of T6.
Design:
Prospective design.
Setting:
Blood pressure monitoring of subjects during a routine bowel program.
Participants:
Ten subjects with chronic (>1 y), complete (American Spinal Injury Association Impairment Scale class A) SCI with a neurologic level of injury above T6.
Interventions:
Not applicable.
Main Outcome Measures:
An increase in systolic blood pressure (SBP) of greater than 20 to 40 mmHg above baseline or an SBP greater than 150 mmHg.
Results:
The mean resting blood pressure for the subject group was 104/65 mmHg. During the bowel program, no subject reported experiencing any of the classic symptoms of autonomic dysreflexia. The mean maximum blood pressure recorded during the bowel program was 160/90 mmHg. All of the patients had an increase in SBP greater than 20 mmHg above baseline, and 70% had an increase in SBP greater than 40 mmHg above baseline. Sixty percent of subjects had an increase in SBP greater than 150 mmHg, with 40% of subjects reaching an SBP greater than 170 mmHg at least once during their bowel program.
Conclusion:
Silent autonomic dysreflexia occurs frequently in SCI during bowel programs. Further study is recommended to determine whether preventative measures or treatment is needed.