COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-0284-7 · Published: April 21, 2020

Spinal Cord Injury COVID-19 Rehabilitation

Simple Explanation

People with spinal cord injuries may experience altered COVID-19 symptoms due to physiological changes. This includes temperature dysregulation, impaired cough, and abnormal sensations. These differences can make it more difficult to diagnose COVID-19 in this population. Individuals with SCI may develop non-specific symptoms during infection, including new or worsening spasticity, neuropathic pain, autonomic dysreflexia, and/or fatigue, which are not consistent with current CDC guidelines for COVID-19. The CDC acknowledges extra considerations are required for individuals with disabilities, but specific risk stratification and/or testing guidelines for people with SCI are not included.

Study Duration

Not specified

Participants

783 health care professionals

Evidence Level

Not specified

Key Findings

1
SCI patients may not exhibit typical COVID-19 symptoms like fever or cough due to their altered physiology.
2
Atypical presentations of COVID-19 in SCI patients can include increased spasticity, rigors, or being asymptomatic.
3
Delayed diagnosis of COVID-19 in SCI patients can occur due to atypical symptom presentation and other underlying conditions.

Research Summary

People with spinal cord injury (SCI) represent a unique diagnostic challenge as it relates to coronavirus disease COVID-19 pandemic. Given the altered physiology described in SCI, atypical presentation of a respiratory illness and COVID-19 requires a heightened suspicion index for COVID-19 infection. The prompt involvement of an SCI-trained physician, whether in-person or virtual, when assessing a patient with new or worsening symptomatology is warranted and advised during the COVID-19 pandemic.

Practical Implications

Increased Vigilance

Healthcare providers should maintain a high level of suspicion for COVID-19 in SCI patients, even with atypical symptoms.

Telemedicine Adaptation

Telemedicine can be used for screening but should address potential disparities in access for people with SCI.

Guideline Expansion

COVID-19 testing criteria and guidelines should be expanded to include atypical symptoms in persons with SCI.

Study Limitations

1
Lack of specific risk stratification and testing guidelines for people with SCI.
2
Potential health disparities hindering access to telemedicine for people with SCI.
3
Atypical symptom presentation in SCI patients complicating diagnosis.

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