Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis

doi:10.1016/j.apmr.2004.03.016

Archives of Physical Medicine and Rehabilitation

Volume 85, Issue 11, November 2004, Pages 1757-1763

https://doi.org/10.1016/j.apmr.2004.03.016 Get rights and content

Abstract

Cardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil 2004;85:1757–63.

Objectives

To examine the frequency and reasons for rehospitalization in persons with acute traumatic spinal cord injury (SCI) during follow-up years and to examine the association between rehospitalization and demographics, neurologic category, payer sources, length of stay (LOS), discharge motor FIM instrument score, and discharge residence.

Design

Survey design with analysis of cross-sectional data.

Setting

Model Spinal Cord Injury Systems (MSCIS) centers.

Participants

Data for 8668 persons with SCI from 16 MSCIS centers entered in the National Spinal Cord Injury Statistical Center database between 1995 and 2002.

Interventions

Not applicable.

Main outcome measures

MSCIS Forms I and II were used to identify the annual incidence, medical complications, and etiologies of rehospitalizations reported at 1-, 5-, 10-, 15-, and 20-year follow-ups.

Results

The leading cause of rehospitalization was diseases of the genitourinary system, including urinary tract infections (UTIs). Diseases of the respiratory system tended to be more likely in patients with tetraplegia (C1–8 American Spinal Injury Association [ASIA] grades A, B, C); whereas patients with paraplegia (T1-S5 ASIA grades A, B, C) were more likely to be rehospitalized for pressure ulcers. The rate of rehospitalization was significantly higher at year 1, 5, and 20 for those who were discharged to a skilled nursing facility after acute rehabilitation. Lower motor score using the FIM was predictive of rehospitalization (P=.000). The average LOS per rehospitalization at the year-5 follow-up was approximately 12 days, which is lower than in past MSCIS reports.

Conclusions

Despite improvements in SCI medical management, rehospitalization rates remain high, with an increased incidence in conditions associated with the genitourinary system (including UTIs), respiratory complications (including pneumonia), and diseases of the skin (including pressure ulcers). Acutely injured patients need close follow-up to reduce morbidity and rehospitalizations.

Section snippets

Study population

Information in the MSCIS database is collected during initial hospitalization—which includes demographic, clinical, injury characteristics, and functional status variables—as well as at the first anniversary and at various anniversaries across the lifespan. Follow-up information collected is designed to monitor outcomes and includes information about recovery and rehospitalization. A rehospitalization is any overnight hospitalization, even a 1-night hospitalization for observation, but does not

Results

Demographics of the sample characteristics are described in table 1 for each 5-year follow-up period beginning with 1 year after discharge from acute rehabilitation. The majority of patients were white men and were either working or students at the time of injury. About two thirds were not married (single, divorced, separated, widowed). Ninety percent were discharged home from acute rehabilitation. Average rehabilitation LOS was significantly longer in those injured in the more distant past (P

Discussion

Long-term, secondary medical complications play an important role in the continuum of care for people with SCI. They are a frequent cause of morbidity and mortality and lead to increased rates of rehospitalization, increased cost of care, loss of employability, and decreased quality of life (QOL).4, 5, 6 MSCIS programs have shown a decline in the annual rehospitalization rate and in LOSs, citing advances in the prevention of secondary medical complications and improved treatment efficiency.2

Conclusions

Rehospitalization rates remain high after SCI with an increased incidence of issues related to genitourinary system, respiratory system, and skin. Several factors, including neurologic level and extent of SCI, decreased functional abilities at discharge from rehabilitation, and payer source, have been shown to influence rehospitalization rates. The rising cost of SCI care, along with the associated personal, vocational, and family impact, make further understanding of these issues important.

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^☆: Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, US Department of Education (grant no. H133N000003-03).

¹: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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ArticlesEtiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis1☆,

Abstract

Objectives

Design

Setting

Participants

Interventions

Main outcome measures

Results

Conclusions

Section snippets

Study population

Results

Discussion

Conclusions

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

The economic impact of spinal cord injury

Guide for the Uniform Data Set for Medical Rehabilitation (adult FIM), version 5.1

The economic consequences of traumatic spinal cord injury

Long-term survival and causes of death

Facts and figures at a glance

J Spinal Cord Med

Management of pulmonary, cardiovascular and metabolic conditions after spinal cord injury

Articles
Etiology and incidence of rehospitalization after traumatic spinal cord injury: A multicenter analysis¹☆,