Baclofen dosage after traumatic spinal cord injury: A multi-decade retrospective analysis

• Over greater than 20 years, oral baclofen dosage was observed to have increased from time of prescription.
• The greatest increase (4.99 mg/year) was observed for patients whose spinal cord injury was caused by a motor vehicle accident.
• After spinal cord injury, gunshot wound patients were prescribed oral baclofen sooner than motor vehicle accident patients.

ObjectivesTo perform an analysis of oral baclofen dosage in patients with traumatic spinal cord injuries over time and to ascertain the clinical determinants of long-term baclofen dosage trends.Study designRetrospective cohort study of patient records from the PM&R units at the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital.SubjectsA total of 115 PM&R patients suffering spinal cord injury due to trauma leading to either complete or incomplete paralysis. The modes of injury included were motor vehicle accidents (MVA) (n = 39), gunshot wounds (GSW) (n = 55), falls (n = 17), diving (n = 2), workplace (n = 1) and swimming (n = 1) accidents. The location of injury in the spinal cord was categorized into either cervical (n = 52), thoracic (n = 59), lumbar (n = 2), or unspecified (n = 2).ResultsFrom time of injury, an aggregate of all dosage assignments for each patient demonstrated a significant yearly increase in baclofen dosage (1.26 mg/year, pˆ<0.01). Baclofen dosage for MVA cases were seen to rise at 4.99 mg/year (pˆ<0.0001). Kaplan–Meier analysis revealed that GSW patients received their first baclofen dosage earlier than MVA patients (log-rank pˆ<0.05, unadjusted).ConclusionsWe observed a marginal increase in baclofen dosage over nearly 25 years in a single provider's patient database and observed different timings of first dose between two causes of traumatic SCI. These results provide an estimate of baclofen dosage trends over time after spinal cord injury and may be useful for patient counseling or as a method to assess costs of providing SCI patient care.