Patterns of morbidity and rehospitalisation following spinal cord injury

Abstract

Study design: Longitudinal, descriptive design. Objectives: The aim of this study was to investigate the frequency, cause and duration of rehospitalisations in individuals with spinal cord injury (SCI) living in the community. Setting: Australian spinal cord injury unit in collaboration with State Health Department. Methods: A data set was created by linking records from the NSW Department of Health Inpatient Statistics Collection between 1989-1990 and 1999-2000 with data from the Royal North Shore Hospital (RNSH) Spinal Cord Injuries Database using probabilistic record linkage techniques. Records excluded were nontraumatic injuries, age o16 years, spinal column injury without neurological deficit, full recovery (ASIA Grade E) and index admission not at RNSH. Descriptive statistics and time to readmission using survival analysis, stratified by ASIA impairment grade, were calculated. Results: Over the 10-year period, 253 persons (58.6%) required one or more spinal-related readmissions, accounting for 977 rehospitalisations and 15,127 bed-days (average length of stay (ALOS) 15.5 days; median 5 days). The most frequent causes for rehospitalisation were genitourinary (24.1% of readmissions), gastrointestinal (11.0%), further rehabilitation (11.0%), skin-related (8.9%), musculoskeletal (8.6%) and psychiatric disorders (6.8%). Pressure sores accounted for only 6.6% of all readmissions, however, contributed a disproportionate number of bed-days (27.9%), with an ALOS of 65.9 (median 49) days and over 50% of readmissions (33 out of 64) occurred in only nine individuals aged under 30 years. Age, level and completeness of neurological impairment, all influenced differential rates of readmission depending on the type of complication. Overall rehospitalisation rates were high in the first 4 years after initial treatment episode, averaging 0.64 readmissions (12.6 bed-days) per person at risk in the first year and fluctuating between 0.52 and 0.61 readmissions (5.1-8.3 bed-days) per person at risk per year between the second to fourth years, before trending downwards to reach 0.35 readmissions (2.0 bed-days) as 10th year approaches. Time to readmission was influenced by degree of impairment, with significantly fewer people readmitted for ASIA D (43.2%) versus ASIA A, B and C (55.2-67.0%) impairments (Po0.0001). The mean duration to first readmission was 46 months overall, however, differed significantly between persons with ASIA A-C impairments (26-36 months) and ASIA D impairment (60 months). Conclusion: Identifying rates, causes and patterns of morbidity is important for future resource allocation and targeting preventative measures. For instance, the late complication of pressure sores in a small subgroup of young males, consuming disproportionately large resources, warrants further research to better understand the complex psychosocial and environmental factors involved and to develop effective countermeasures.

Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study

“…1,5 In the Australian study, Middleton et al, using data with the Royal North Shore Hospital SCI Database in New South Wales from 1989-1990 to 1999-2000 in 432 patients, reported an overall rehospitalization rate in the first 12 months after discharge of 36%. In the Canadian study, the cases were from 1992 and 1994 and, in the first year following discharge, 22.5% were rehospitalized, which is similar to the current study.…”

“…5 These studies have reported that approximately one-third of persons with a traumatic SCI will be rehospitalized each year. 6 These hospitalizations are not only costly to the healthcare system but also to the individual with SCI in terms of increased difficulty in obtaining or sustaining employment or becoming involved in other gainful or leisure activities and a reduced quality of life.…”

Health-related outcomes of people with spinal cord injury—a 10 year longitudinal study

“…4 Mean LOSs ranging from 4 to 34 days are reported. 1,[3][4][5]10,13,31 In a comprehensive Australian review of hospital readmissions, 58.6% had been readmitted to hospital for an SCI-related episode on one or more occasions over 10 years with an average LOS of 15.5 days. 31 The reasons for hospitalization are similar in all studies, with respiratory, skin and urinary complications contributing to the majority of admissions.…”

Factors affecting length of hospital stay for people with spinal cord injuries at Kanombe military hospital, Rwanda

“…The researcher developed this instrument based on a previous study (Middleton et al, 2004). The final data gathering sheet was divided into sections A and B.…”

“…These may interfere with health and well being, social activity, produtive employment and quality of life (Middleton et al 2004;Ackery et al 2004). Patients are often re admitted to hospital due to complications with the genitourinary, gastrointestinal, skin, musculoskeletal, neurological, respiratory and cardiovascular systems (Middleton et al 2004;Savic et al 2000). The occurrence of pressure sores is among the most common long term secondary medical complication in persons with SCI (Garber and Rintala 2003).…”