With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.

Study design: Cohort study. Objectives: To provide recent estimates of the incidence of traumatic spinal cord injury (SCI) in adults living in Ontario. Setting: Ontario, Canada. Methods: The study included all men and women aged 18 years and older living in Ontario. The two primary data sources used for this study were the census data provided by Statistics Canada and the hospital Discharge Abstract Database (DAD) provided by the Canadian Institute for Health Information. Incidence was estimated for the fiscal years 2003/04-2006/07, and examined by age, gender, mechanism and seasonality of injury, the level of injury, the presence of comorbidity and in-hospital mortality. Results: The incident cases had a mean age of 51.3 years (s.d. 20.1). The majority of the cases was male (74.1%) and had a cervical SCI caused by falls (49.5%). The age-adjusted incidence rate was stable over the 4-year study period, from 24. Conclusion: Despite worldwide trends that have indicated motor vehicle collisions (MVCs) as the leading cause of injury, falls emerged as the leading cause of traumatic SCI in this study. This finding, and the fact that the number of fall-induced injuries increased steadily with age, may indicate that there is growing concern for the consequences of falls in the elderly. Further work is needed to understand this trend in age and gender and the causes of falls to develop effective fall prevention strategies.

Study Design: Retrospective cohort design. Objectives: To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation. Setting: Ontario, Canada. Methods: Inpatient stays (2003)(2004)(2005)(2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization. Results: NTSCI cases (n ¼ 1002) were greater than TSCI (n ¼ 560). NTSCIs were older (mean ¼ 61.6, s.d. ¼ 15.8) with more co-morbidities, paraplegic (39.5%) and female (Po0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median ¼ 24) and 29.7 (median ¼ 22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR ¼ 1.5; 95% CI ¼ 1.2-1.9), urban living (OR ¼ 1.59; 95% CI ¼ 1.12-2.22) and lowest quartile (18-88) discharge FIM (OR ¼ 1.8; 95% CI ¼ 1.4-2.3). Charlson score of 3 or more (OR ¼ 2.1; 95% CI ¼ 1.3-3.2), urban living (OR ¼ 1.92; 95% CI ¼ 1.3-2.86) and lowest quartile discharge FIM (OR ¼ 1.5; 95% CI ¼ 1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR ¼ 1.5; 95% CI ¼ 1.1-2.1), low income (OR ¼ 1.4; 95% CI ¼ 1.1-1.9) and low (18-88) discharge FIM (OR ¼ 1.7; 95% CI ¼ 1.3-2.2). Conclusion: Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.