The impact of polytrauma on rehabilitation outcomes for patients with Spinal cord injury.

Spinal cord injury (SCI) recovery is variable and can be complicated by concomitant polytrauma. While previous studies suggest worse rehabilitation outcomes in polytrauma patients, comparative analyses remain limited. This study evaluates the impact of polytrauma on motor, sensory, and functional outcomes for patients with SCI. To do so, a retrospective cohort study was done to evaluate patients with polytrauma (poly-SCI) and without polytrauma (SCI-only) in addition to SCI. Polytrauma was defined as the presence of two injuries with an abbreviated injury scale (AIS) severity score ≥ 3 in two distinct body regions. Primary outcomes included changes in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) injury grade, total motor score (TMS), neurologic level of injury (NLI), and Section GG functional scores from rehabilitation (rehab) admission to discharge. Of the 146 patients identified for study inclusion between 2019 and 2024; 81 patients were SCI-only and 65 were poly-SCI. The poly-SCI cohort was younger (36.0 vs. 52.0 years; p = 0.006), sustained more high-energy injuries, and experienced longer acute hospital stays (9.5 vs. 6 days; p < 0.001). Consequently, the poly-SCI group exhibited a greater proportion of ISNCSCI Grade A injuries compared to the SCI-only group (46% vs. 19%; p = 0.005), although baseline TMS at admission was similar between cohorts (52.34 vs. 51.94; p = 0.899). Regarding recovery across acute rehab, the poly-SCI cohort demonstrated significantly smaller improvements in TMS between admission and discharge compared to the SCI-only group (3.0 vs. 9.0; p < 0.001). However, no significant differences were observed in changes in ISNCSCI grade, NLI, and Section GG functional scores. Multivariable linear regression with analysis of covariance (ANCOVA) further confirmed that polytrauma status was not significantly associated with changes in Section GG scores. Instead, age and admission TMS emerged as the only significant predictors of functional improvement. Further work is needed to clarify domain-specific recovery patterns and long-term effects.