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Acute

Spinal Cord Injury Data Collection Form


Type of spinal cord injury ________________________________ Date and time of injury ___________________________________ Patient length of stay _____________________________________ 1. Was patient started on methylprednisolone? Yes

No


No unknown start time

If so was how long after the time of injury was the therapy initiated? Less than 3 hours

3-8 hours

Greater than 8 hours

Did the patient receive the full course of therapy? Yes


Enoxaparin

2. Which VTE prophylaxis was the patient put on? Low molecular weight heparin

If started on LMWH, what was the dose and frequency? _____________________________ If started on enoxaparin, what was the dose and frequency? 30mg q12 Other 40mg daily


Phenylephrine

3. If any, which vasopressor was patient started on? Norepinephrine (Levophed)

Dopamine

Other

If other was selected, please indicate which vasopressor was used _______________________ 4. American Spinal Cord Injury (ASIA) score? A


Date records were accessed _____________________________

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