ARE WE TRAINING MEDICAL STUDENTS TO MANAGE AUTONOMIC DYSREFLEXIA IN SPINAL CORD INJURY? A STUDY

  • Muath Ibrahim ALfallaj Qassim University, College of Medicine, Department of Surgery, Kingdom of Saudi Arabia
  • Sajad Ahmad Salati Qassim University, College of Medicine, Department of Surgery, Kingdom of Saudi Arabia
Keywords: Spinal cord injury, autonomic dysreflexia, stroke, hypertension, pain, faecal impaction, pressure ulcer, foley’s catheter

Abstract


Background: Autonomic dysreflexia (AD) is a potentially life-threatening complication of spinal cord injury (SCI), characterized by sudden, paroxysmal episodes of hypertension. Healthcare professionals and family members caring for individuals with SCI must be able to recognize and manage AD promptly and appropriately. This study aimed to assess the level of knowledge about AD among final-year medical students, evaluate their preparedness to manage AD, and highlight the importance of educating families of SCI patients on its recognition and management.

Methods: A questionnaire-based, descriptive cross-sectional study was conducted among final-year (MD-4) medical students at the College of Medicine, Qassim University. Data were collected, cleaned, and analyzed using Microsoft Excel 2021. Students were then categorized into three groups based on their knowledge level: poor, fair, and good.

Results: Significant gaps were identified in students’ knowledge of AD. Out of 68 students initially surveyed, 24 (35.3%) had not heard of AD and were excluded. Among the 44 participants included in the final analysis, scores ranged from 4 to 12 out of a maximum of 21, with a mean score of 7.02 (33.4%). A total of 27 students (61%) were classified as having poor knowledge, and 17 (39%) as fair. None of the students qualified for the “good” knowledge category.

Conclusions: The findings underscore the need for incorporating autonomic dysreflexia into the undergraduate medical curriculum. Early education would ensure that medical graduates are better prepared to manage AD and can help prevent complications by educating patients’ families.

Author Biography

Sajad Ahmad Salati, Qassim University, College of Medicine, Department of Surgery, Kingdom of Saudi Arabia

Professor , Department of Surgery , College of Medicine , Qassim University , Kingdom of Saudi Arabia

References

Cowan H, Lakra C, Desai M. Autonomic dysreflexia in spinal cord injury. BMJ. 2020 Oct 2;371:m3596. doi: 10.1136/bmj.m3596.

Morgan S. Recognition and management of autonomic dysreflexia in patients with a spinal cord injury. Emerg Nurse. 2020;28(1):22-7. doi: 10.7748/en.2019.e1978.

Lakra C, Swayne O, Christofi G, Desai M. Autonomic dysreflexia in spinal cord injury. Pract Neurol. 2021;21(6):532-8. doi: 10.1136/practneurol-2021-002956.

Colachis SC, Fugate LP. Autonomic dysreflexia associated with transient aphasia. Spinal Cord. 2002;40(3):142-4. doi: 10.1038/sj.sc.3101251.

Colachis SC , Clinchot DM. Autonomic hyperreflexia associated with recurrent cardiac arrest: case report. Spinal Cord. 1997;35(4):256-7. doi: 10.1038/sj.sc.3100359.

Pan SL, Wang YH, Lin HL, Chang CW, Wu TY, Hsieh ET. Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report. Arch Phys Med Rehabil. 2005;86(3):591-3. doi: 10.1016/j.apmr.2004.03.021.

Vaidyanathan S, Soni BM, Hughes PL, Oo T. Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned. Int Med Case Rep J. 2018; 11:53-8. doi:10.2147/IMCRJ.S143077

Eker A, Yigitoglu PH, Ipekdal HI, Tosun A. Acute onset of intracerebral hemorrhage due to autonomic dysreflexia. J Korean Neurosurg Soc. 2014;55(5):277-9. doi: 10.3340/jkns.2014.55.5.277.

Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J Spinal Cord Med. 2014;37(1):2-10. doi: 10.1179/2045772313Y.0000000098.

Phillips AA, Krassioukov AV. Contemporary cardiovascular concerns after spinal cord injury: Mechanisms, maladaptations, and management. J Neurotrauma. 2015;32(24):1927-42. doi: 10.1089/neu.2015.3903.

Rempel L, Sachdeva R, Krassioukov AV. Making the invisible visible: understanding autonomic dysfunctions following spinal cord injury. Phys Med Rehabil Clin N Am. 2025;36(1):17-32. doi: 10.1016/j.pmr.2024.07.002.

Alwashmi AH. Spinal cord injury and autonomic dysreflexia: a case report on an overlooked complication of spinal cord injury. Cureus. 2022;14(10):e30259. doi: 10.7759/cureus.30259.

Kaydok E. Nurses and physiotherapists' knowledge levels on autonomic dysreflexia in a rehabilitation hospital. J Spinal Cord Med. 2023;46(4):569-73. doi: 10.1080/10790268.2021.1983313.

Tederko P, Ugniewski K, Bobecka-Wesołowska K, Tarnacka B. What do physiotherapists and physiotherapy students know about autonomic dysreflexia? J Spinal Cord Med. 2021;44(3):418-24. doi: 10.1080/10790268.2019.1645966.

Strcic N, Markic D. The knowledge about autonomic dysreflexia among nursing and physiotherapy students. J Spinal Cord Med. 2019;42(6):791-6. doi: 10.1080/10790268.2018.1439432.

McGillivray CF, Hitzig SL, Craven BC, Tonack MI, Krassioukov AV. Evaluating knowledge of autonomic dysreflexia among individuals with spinal cord injury and their families. J Spinal Cord Med. 2009;32(1):54-62. doi: 10.1080/10790268.2009.11760753.

Trueblood CT, Singh A, Cusimano MA, Hou S. Autonomic dysreflexia in spinal cord injury: mechanisms and prospective therapeutic targets. Neuroscientist. 2024;30(5):597-611. doi: 10.1177/10738584231217455.

Sharif H, Hou S. Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury. Neural Regen Res. 2017;12(9):1390-1400. doi: 10.4103/1673-5374.215241.

Squair JW, Phillips AA, Harmon M, Krassioukov AV. Emergency management of autonomic dysreflexia with neurologic complications. CMAJ. 2016;188(15):1100-3. doi: 10.1503/cmaj.151311.

Caruso D, Gater D, Harnish C. Prevention of recurrent autonomic dysreflexia: a survey of current practice. Clin Auton Res. 2015;25(5):293-300. doi: 10.1007/s10286-015-0303-0.

Bakhsh A, Aljuzair AH, Eldawoody H. An Epidemiological overview of spinal trauma in the Kingdom of Saudi Arabia. Spine Surg Relat Res. 2020;4(4):300-4. doi: 10.22603/ssrr.2019-0118.

Alshahri SS, Cripps RA, Lee BB, Al-Jadid MS. Traumatic spinal cord injury in Saudi Arabia: an epidemiological estimate from Riyadh. Spinal Cord. 2012;50(12):882-4. doi: 10.1038/sc.2012.65.

Al-Habib A, Alaqeel A, Marwa I, Almohammadi M, Al Shalaan H, AlEissa S, et al. Causes and patterns of spine trauma in children and adolescents in Saudi Arabia: implications for injury prevention. Ann Saudi Med. 2014;34(1):31-7. doi: 10.5144/0256-4947.2014.31.

Lucci VM. Recent updates in autonomic research: advances in the understanding of autonomic dysfunction after spinal cord injury. Clin Auton Res. 2023;33(2):83-5. doi: 10.1007/s10286-023-00944-y.

Krassioukov A, Stillman M, Beck LA. A primary care provider's guide to autonomic dysfunction following spinal cord injury. Top Spinal Cord Inj Rehabil. 2020 Spring;26(2):123-7. doi: 10.46292/sci2602-123.

Published
2025/06/30
Section
Original article