Talk:Spinal cord injury/GA1

GA Review
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Reviewer: Looie496 (talk · contribs) 17:37, 2 February 2016 (UTC)

I am happy to review such an important article. On an initial reading I foresee no serious difficulty in approving it. The main thing I feel a lack of is a sketch of information that would improve understanding for readers who know very little about spinal structure and function -- in particular a few more pictures, such as the ones you can find in spinal cord, peripheral nervous system and dermatome (anatomy). Looie496 (talk) 17:37, 2 February 2016 (UTC)
 * Oh, hey, thanks so much for reviewing this. I'm sorry I didn't notice until just now! I'm a doof.  I can definitely do that.  In fact I had thought of adding a "relevant anatomy" section before Classification.  What do you think?  delldot   &nabla;.  07:34, 7 February 2016 (UTC)
 * I added three images and some info in the classification section. Please let me know if there is more I should add. Thanks again!  delldot   &nabla;.  08:54, 7 February 2016 (UTC)
 * By the way, I'm confident that the page the copyvio detector is hitting on was actually copied from an older version of this article. This one predated that page and actually included cv content from a third page that I found and eradicated!  Also a sentence I wrote myself in May 2014 shows up in that article.  delldot   &nabla;.  06:44, 9 February 2016 (UTC)

I am now beginning the detailed review. I will make minor copy-edits if I think they would improve it, but if I mess anything up please feel free to revert. Looie496 (talk) 19:23, 9 February 2016 (UTC)

Complete and incomplete injuries

 * This includes a phenomenon known as sacral sparing... This wording is unclear. Does incomplete injury always imply sacral sparing, or only sometimes? Looie496 (talk) 19:23, 9 February 2016 (UTC)
 * Clarified: Incomplete injury by definition includes a phenomenon known as sacral sparing: some degree of sensation is preserved in the sacral dermatomes... delldot   &nabla;.  01:06, 10 February 2016 (UTC)
 * ✅ Looie496 (talk) 18:07, 11 February 2016 (UTC)

Causes

 * nontraumatic lesions cause anywhere from 30 to 80% of all SCI This range is so huge that it requires some explanation. Looie496 (talk) 18:07, 11 February 2016 (UTC)
 * Added: 30 to 80% of all SCI;[54] the percentage varies by locale, influenced by efforts to prevent trauma.[55] Developed countries have higher percentages of SCI due to degenerative conditions and tumors than developing countries. delldot   &nabla;.  22:19, 11 February 2016 (UTC)
 * ✅ Looie496 (talk) 15:59, 12 February 2016 (UTC)

Early hospital treatent

 * However, surgery is controversial because it has potential complications (such as infection) and has not been conclusively shown to be more or less effective than a conservative, nonsurgical approach. This seems to contradict statement earlier in the paragraph. Looie496 (talk) 18:26, 11 February 2016 (UTC)
 * Does this clarify enough? However, surgery is controversial because it has potential complications (such as infection), and by the highest standards of scientific investigation, it has not been conclusively found to have better outcomes than a conservative, nonsurgical approach.[88] Doctors must thus decide whether to perform surgery based on aspects of the patient's condition and their own beliefs about its risks and benefits. If not I can add more. delldot   &nabla;.  07:31, 12 February 2016 (UTC)
 * The basic issue (which I should have pointed out more clearly) is that the word "necessary" is used earlier in the paragraph, but this material suggests that it may not be necessary. Looie496 (talk) 15:03, 12 February 2016 (UTC)
 * My understanding is it is definitely necessary in some cases (e.g. penetrating object) but more controversial in others. I will work on finding a source to confirm this & clarify in the article.  delldot   &nabla;.  20:15, 12 February 2016 (UTC)
 * Added a bit about timing and changed that wording to this: Surgery is controversial because it has potential complications (such as infection), so in cases where it is not clearly needed (e.g. the cord is being compressed), doctors must decide whether to perform surgery based on aspects of the patient's condition and their own beliefs about its risks and benefits. delldot   &nabla;.  03:12, 13 February 2016 (UTC)
 * ✅ Looie496 (talk) 15:09, 13 February 2016 (UTC)

Prognosis

 * People with nontraumatic causes of SCI have been found to be less likely to suffer complete injuries and some complications such as pressure sores and deep vein thrombosis, and to have shorter hospital stays. Their scores on functional tests were better than those of people with traumatic SCI upon hospital admission, but the same upon discharge. This is a bit difficult to follow. It seems to say that nontraumatic SCI is on average less severe but shows less recovery.  If that is a correct reading, perhaps it could be stated more directly? Looie496 (talk) 15:30, 12 February 2016 (UTC)
 * The source doesn't have an explanation for these findings, but I think your read is correct. My guess is that a slower onset (e.g. tumor) presents with less spinal shock. Does this clarify enough? Their scores on functional tests were better than those of people with traumatic SCI upon hospital admission, but when they were tested upon discharge, those with traumatic SCI had improved such that both groups' results were the same.  delldot   &nabla;.  03:31, 13 February 2016 (UTC)
 * ✅ Looie496 (talk) 15:09, 13 February 2016 (UTC)

Epidemiology

 * The estimated prevalence (number of people living with SCI) ranges from 236 per million in India to 1800 per million in the US. In Western Europe the prevalence is 300 per million people and in North America it is 853 per million. The figure for the US is not compatible with the figure for North America -- over half the population of North America lives in the US, so you couldn't get those numbers even if the rate was zero outside the US. Looie496 (talk) 15:45, 12 February 2016 (UTC)
 * Ooh, good catch. After further research it looks like the the 1800 figure is the one that's out of whack.  I made several additions and edited the prevalence info to correct that: In the United States ... different studies have estimated prevalences from 525 to 906 per million.
 * ✅ Looie496 (talk) 15:09, 13 February 2016 (UTC)

Wrapup
I have completed my review, and once the issues raised above are resolved I will approve the article for GA. Looie496 (talk) 15:58, 12 February 2016 (UTC)
 * Thank you so much for this thoughtful and thorough review Looie496! I appreciate your time.  delldot   &nabla;.  04:05, 13 February 2016 (UTC)
 * It was a pleasure. Looie496 (talk) 15:09, 13 February 2016 (UTC)
 * Thanks again! :D delldot   &nabla;.  01:29, 14 February 2016 (UTC)