Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury—1990–1997

Eastwood, Elizabeth A.; Hagglund, Kristofer J.; Ragnarsson, Kristjan T.; Gordon, Wayne A.; Marino, Ralph J.

doi:10.1016/s0003-9993(99)90258-7

Cited by 151 publications

(137 citation statements)

References 8 publications

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“…The choice of interviewing prevented us from registering the exact date of admissions; therefore, the annual rate of re-admission could not be estimated nor compared with that reported in literature. [14][15][16] The major cause of re-admission was the need for further rehabilitation, unlike reports elsewhere which indicate specific complications as being the most common cause. 14,17,18 Re-admission of patients for further rehabilitation may suggest an effort to improve function at the highest achievable level.…”

Section: Discussionmentioning

confidence: 99%

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

Pagliacci¹,

Franceschini²,

Clemente³

et al. 2006

Spinal Cord

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Study design: Prospective, multicentred follow-up (FU) observational study. Objectives: Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). Setting: Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. Method: A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. Results: Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.870.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. Conclusion: Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.

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Section: Discussionmentioning

confidence: 99%

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

Pagliacci¹,

Franceschini²,

Clemente³

et al. 2006

Spinal Cord

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“…Some studies that analyze LOS separate acute care hospitalization from rehabilitation hospitalization and stipulate a time limit from the injury date as an inclusion criterion. [10][11][12][13] Others calculate the LOS from the day of injury, 14 include individuals admitted for their initial episode 15 or use date of the index hospitalization as the date of the SCI. 16 All these studies lack further analysis regarding possible divergence between the onset of traumatic SCI and admission date.…”

Section: Is An Inpatient Stay Associated With the Injury Date?mentioning

confidence: 99%

“…19 These studies all have different inclusion criteria, terms of description and grouping when it comes to etiology, age, injury year, level and extent of injury and type of care. [10][11][12][13][15][16][17]20 This impedes comparison. No discussion has been found in any of the published studies about how realistic it is to have very few or many inpatient days registered.…”

Section: On the Need Of Validating Inpatient Registers C Nordgrenmentioning

confidence: 99%

“…Some researchers do not examine the acute LOS, for example. 15,16 Several studies [11][12][13]20 spring from persons discharged from the Model System with an enrol system of patients being admitted within 60 days of injury. In some studies, 86-93% of all patients were admitted to the investigated clinics within 21 days of injury.…”

Section: On the Need Of Validating Inpatient Registers C Nordgrenmentioning

confidence: 99%

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On the need of validating inpatient registers

Nordgren

2008

Spinal Cord

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Study design: Register study. Objectives: To design and implement a validation process to check the completeness of the Hospital Discharge Register (HDR) held by the Swedish National Board of Health and Welfare. Setting: Sweden. Methods: An accurate traumatic spinal cord injury prevalence group (n ¼ 495) was acquired from the Swedish Spinalis Clinic. A register control was performed on the group by raising three questions to check the validity of the HDR: Is an inpatient stay registered in association with the injury date? Is the reported first length of stay plausible, given the level and extent of injury? Are all the anticipated care and/or rehabilitation providers represented in the HDR? Results: For 62% (of 413 cases) the first registered hospitalization date correlated with the injury date. For the other 38%, hospitalization was reported to start between 2 and 8651 days after injury. Considering the level and extent of injury, individuals were reported to have unrealistically short initial hospitalization. The prevalence group visited 42 different hospitals and 47 clinics. Five rehabilitation clinics, though, were not reported. Conclusions: The HDR is a valuable source when conducting epidemiological and health services research. However, using the register without any validation process could, as detected in the investigated diagnosis group, lead to a severe underestimation of the inpatient usage. The study showed that systematic errors could be detected by means of extensive knowledge of the diagnosis group.

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“…Prior studies that reported on LOS and payment for acute hospitalization and rehabilitation were either based on NSCID 1,4,[8][9][10][11] or state-specific populations. 7,12 As several of the studies [8][9][10][11] reported LOS and payments for all levels of SCI combined, it is difficult to make comparisons with the current findings.…”

Section: Acute Hospitalization and Rehabilitationmentioning

confidence: 99%

Services provided following compensable work-related tetraplegia

et al. 2004

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Design: Descriptive study. Objective: To describe and compare the medical services provided following work-related tetraplegic spinal cord injury (SCI). Setting: Workers' compensation claims database. Methods: The administrative database of a workers' compensation provider was searched for work-related tetraplegia claims with dates of injury between 1 January 1989 and 31 December 1999. In total, 62 cases were identified and grouped by impairment category. Medical payment data were extracted and assigned to service categories. Results: Although the level of services was directly related to the severity of impairment, patterns were similar across categories; for example, the largest proportions of payments were associated with durable medical equipment (DME) and attendant care in each impairment category. DME, readmissions and attendant care services varied considerably from year to year and within impairment category. Payments for physician care and medications/supplies showed the least variation within impairment categories. Workers' compensation payments were similar to National Spinal Cord Injury Database (NSCID) payments for the first year following injury; however, in subsequent years, workers' compensation figures were much higher. Conclusions: Differences in annual medical payment and services by impairment category appear to be primarily due to variations in DME, attendant care and readmission. Payment differences in relation to National SCI figures may be related to better capture of payments by the workers' compensation administrative database. In addition, results suggest broader coverage by workers' compensation for medical services and items related to independent living.

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Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury—1990–1997

Cited by 151 publications

References 8 publications

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

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

On the need of validating inpatient registers

Services provided following compensable work-related tetraplegia

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