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Arch Phys Med Rehabil · Nov 2004
Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.
- Diana D Cardenas, Jeanne M Hoffman, Steven Kirshblum, and William McKinley.
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA. dianamac@u.washington.edu
- Arch Phys Med Rehabil. 2004 Nov 1;85(11):1757-63.
ObjectivesTo 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.DesignSurvey design with analysis of cross-sectional data.SettingModel Spinal Cord Injury Systems (MSCIS) centers.ParticipantsData for 8668 persons with SCI from 16 MSCIS centers entered in the National Spinal Cord Injury Statistical Center database between 1995 and 2002.InterventionsNot applicable.Main Outcome MeasuresMSCIS 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.ResultsThe 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.ConclusionsDespite 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.
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