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

Abstract

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.

A multicentre follow-up of clinical aspects of traumatic spinal cord injury

“…SU, being located in large hospitals, have facilities for treating patients immediately after the SCI and supplying comprehensive rehabilitation, whereas RC have only rehabilitation facilities. 5 Five hundred and eleven out of 608 first-admission traumatic SCI patients discharged to home from 24 centres participating in the previous epidemiological prospective survey, 5 were located. Four hundred and three subjects (79%) completed the interview, 72 (14%) abstained from giving their consent, whereas the remaining 36 (7%) had died.…”

“…In Italy, the GISEM (Italian Group for the Epidemiological Study of Spinal Cord Injuries) survey was performed to determine the standing of health care and rehabilitation made available to acute SCI patients. 5 The data obtained pointed to a number of critical points, such as lack of standardised treatment owing to an uneven distribution of SCI centres in the country, and lack of an early comprehensive approach to rehabilitation. As a result, patients can have a long wait before being admitted to SCI centres and frequently present with complications, such as pressure sores, that call for a prolonged length of stay (LoS) and represent a poor prognostic factor for being discharged home.…”

Risk factors for pressure ulceration in a resource constrained spinal injury service

“…Previous reports have identified delayed presentation, low serum proteins, premorbid medical condition such as diabetes, and completeness of the spinal cord injury as risk factors for pressure ulceration. [3][4][5][6][7][8][9][10][11] The organisation of healthcare in Nigeria is the responsibility of three tiers of the government. The federal government has the overall responsibility for the university teaching hospitals teachings in hospitals and the three National Orthopaedic Hospitals, which are involved in the management of major trauma such as spinal injury.…”

Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study

“…Data from other settings, report rates of pressure ulcers on the first annual follow-up year post-trauma to range between 12 and 36%. [17][18][19][20] In some of these studies, pressure ulcers were the most frequent medical complication, with an increasing rate in later follow-ups. 19 Cases transferred early to a SCI system of care were reported to suffer a statistically significant lower number of ulcers as compared with those admitted later.…”