Benefits of early admission to an organised spinal cord injury care system

DeVivo, Michael J.; Kartus, Paula L.; Stover, Samuel L.; Fine, Philip R.

doi:10.1038/sc.1990.74

Cited by 57 publications

(41 citation statements)

References 5 publications

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“…However, several studies have shown that lengths of hospitalization, costs of care, mortality rates, and medical complication rates are lower, whereas functional outcomes are better for patients treated at model systems than for patients treated elsewhere. [36][37][38][39] Therefore, given that only 10-15% of all new SCI in the United States each year are treated at model systems, overall outcomes are probably slightly overestimated by this study. 11 Moreover, it is possible that trends in model system treatment outcomes are not representative of trends in outcomes for patients treated elsewhere.…”

Section: Study Limitationsmentioning

confidence: 99%

Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

DeVivo

2007

Spinal Cord

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Study design: Consecutive case series with 5-year follow-up. Objective: To evaluate the spinal cord injury (SCI) model systems program in the United States by documenting improvements in treatment outcomes over time. Setting: SCI model systems throughout the United States. Methods: Initial data were collected on 24 332 patients injured between 1973 and 2006. Follow-up data were collected on 9225 of these patients 5 years post-injury. All data were grouped by calendar year. Descriptive statistics included means and percentages. Multiple linear or logistic regression was used to assess outcome trends after adjusting for demographics and injury severity. Results: Acute care and rehabilitation lengths of stay declined dramatically over time (Po0.01). Mean functional independence measure motor score at discharge and gain during rehabilitation decreased, whereas gain per day increased (Po0.01). The probability of neurologic improvement from admission to discharge increased. Odds of medical complications decreased during in-patient treatment, but increased post-discharge (Po0.05). Rehospitalizations declined over time (Po0.01). Community integration improved. First year mortality rates improved, but longer term mortality rates showed no improvement since 1982. Conclusions: Steady improvements have occurred for many treatment outcomes. Newer and more effective methods of prevention and treatment need to be developed to target those outcomes that have not improved and remain suboptimal.

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Section: Study Limitationsmentioning

confidence: 99%

Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

DeVivo

2007

Spinal Cord

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“…One of its primary goals was to evaluate the efficiency of such a system. 3 Although several studies have demonstrated that patients admitted to model SCI systems soon after injury tend to have better short-and long-term outcomes than patients whose admission to a model system is delayed, [4][5][6] information on acute care in non-model system facilities has been limited. Therefore, the original mission to evaluate the effectiveness of treatment programs at these nine model SCI systems of care compared with traditional care proved difficult.…”

Section: Introductionmentioning

confidence: 99%

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center

et al. 2010

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Study design: Retrospective database review. Objective: To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Background: Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Methods: Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n ¼ 78) and from non-SCI centers (n ¼ 131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Results: Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P ¼ 0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (Po0.001). Conclusion: Acute care in organized SCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

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“…The relative shortage of spinal units (seven with a total 200 beds) does not permit all patients with spinal cord lesion to be admitted immediately to model centres where acute and rehabilitative interventions are integrated. 2 The lack of a standardised course between care in acute wards and a rehabilitation programme, means that the population arriving at the rehabilitation centres is very heterogeneous: after a wide range of time from the acute event, in different clinical conditions depending on previous management, 3 and possibly having undergone a selection connected to their aetiology.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord lesion management in Italy: a 2-year survey

et al. 2003

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Objectives: To compare the route from injury to rehabilitation, and the outcome of care in a large sample of traumatic (T) and nontraumatic (NT) spinal cord lesion (SCL) patients at their 'first admission'. Setting: T and NT SCI patients consecutively admitted to 37 SCL centres in Italy. Method: Data were recorded on simple, computerised, closed-question forms, which were Centrally collected and analysed. Descriptive and inferential analysis was conducted to define the characteristics and compare the T and NT populations, and to identify correlations among the variables examined: time from the event to admission (TEA); pressure sores (PS) on admission; length of stay (LoS) and destination on discharge. Results: A total of 1014 SCL patients, 67.5% with a lesion of T and 32.5% of NT aetiology were analysed. The subjects in the T group were younger (median 34 versus 58 years), with higher probability of cervical involvement (OR 2.47, CI 1.8-3.4) and completeness of the lesion (OR 3.0, CI 2.3-4.0), shorter median TEA(37 versus 64 days, Po0.0001) and less frequent admission from home (3.6 versus 17.4%) compared to the NT group. TEA and PS on admission were analysed as indicators of the efficacy of the courses from injury to rehabilitation. Longer TEA was reported for people with NT aetiology, admitted to rehabilitation centre (RC), not locally resident, transferred from certain wards and to a lesser degree female subjects and those with complications on admission. PS were associated to www.nature.com/sc completeness of lesion, longer TEA, admission to RC, nonlocal residence and coming from general intensive care units, or general surgery wards. Median LoS was 99 days (mean 116 and range 0-672), and was statistically shorter in the NT group (122 versus 57 median, Po0.00001). Upon discharge, bladder and bowel autonomy were, respectively, obtained in 68.1 and 64.5% of the whole population without significant difference between the T and NT groups. A total of 80.2% of patients were discharged home and the following factors: not living alone, being discharged after longer LoS, having sphincterial autonomy and no PS, were all independent predictors of outcome. Conclusion: There are important obstacles in the admission route to rehabilitation facilities, greater for NT, as longer TEA and more complications on admission testify. Moreover, the LoS is shorter for NT population. Our findings suggest that rehabilitation outcome could be improved through an early multidisciplinary approach and better continuity between acute and rehabilitation care, especially for the 'neglected' NT SCL patients.

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Benefits of early admission to an organised spinal cord injury care system

Cited by 57 publications

References 5 publications

Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center

Spinal cord lesion management in Italy: a 2-year survey

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