Abstract
Design: Prospective 2-year survey from 1 February 1997 to 31 January 1999.
Objectives: To compare the route from injury to rehabilitation, and the outcome of care in a large sample of traumatic (T) and nontraumatic (NT) spinal cord lesion (SCL) patients at their ‘first admission’.
Setting: T and NT SCI patients consecutively admitted to 37 SCL centres in Italy.
Method: Data were recorded on simple, computerised, closed-question forms, which were Centrally collected and analysed. Descriptive and inferential analysis was conducted to define the characteristics and compare the T and NT populations, and to identify correlations among the variables examined: time from the event to admission (TEA); pressure sores (PS) on admission; length of stay (LoS) and destination on discharge.
Results: A total of 1014 SCL patients, 67.5% with a lesion of T and 32.5% of NT aetiology were analysed. The subjects in the T group were younger (median 34 versus 58 years), with higher probability of cervical involvement (OR 2.47, CI 1.8–3.4) and completeness of the lesion (OR 3.0, CI 2.3–4.0), shorter median TEA(37 versus 64 days, P<0.0001) and less frequent admission from home (3.6 versus 17.4%) compared to the NT group. TEA and PS on admission were analysed as indicators of the efficacy of the courses from injury to rehabilitation. Longer TEA was reported for people with NT aetiology, admitted to rehabilitation centre (RC), not locally resident, transferred from certain wards and to a lesser degree female subjects and those with complications on admission. PS were associated to completeness of lesion, longer TEA, admission to RC, nonlocal residence and coming from general intensive care units, or general surgery wards. Median LoS was 99 days (mean 116 and range 0–672), and was statistically shorter in the NT group (122 versus 57 median, P<0.00001). Upon discharge, bladder and bowel autonomy were, respectively, obtained in 68.1 and 64.5% of the whole population without significant difference between the T and NT groups. A total of 80.2% of patients were discharged home and the following factors: not living alone, being discharged after longer LoS, having sphincterial autonomy and no PS, were all independent predictors of outcome.
Conclusion: There are important obstacles in the admission route to rehabilitation facilities, greater for NT, as longer TEA and more complications on admission testify. Moreover, the LoS is shorter for NT population. Our findings suggest that rehabilitation outcome could be improved through an early multidisciplinary approach and better continuity between acute and rehabilitation care, especially for the ‘neglected’ NT SCL patients.
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Acknowledgements
We thank Dr MJ De Vivo for his useful advice. We are grateful to Hilary Ann Giles (MA) for reviewing the English language of the paper. We also thank the ‘Fondazione M. Taramelli per la ricerca sulla mielolesione’ and Umbria-Regional Health Administration Area for supporting the study with a grant for statistical elaboration.
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GISEM group: Guiding Committee and coordinating office: M Franceschini, S Aito, MG Celani, A Citterio, G Finali, D Loria, MC Pagliacci, S Ricci, M Taricco, L Spizzichino and M Zampolini.
Clinica di Neuroriabilitazione, Ancona: L Provinciali, M Danni; SRRF Ospedale Maggiore, Parma: M Boselli, M Franceschini; SRRF Policlinico S Orsola Malpighi, Bologna: M Menarini, M Alianti, L Landi; SRRF Ospedale Bellaria, Bologna: MP Ferrari, G Domenicucci; DRRF Ospedale Maggiore, Bologna: R Piperno, N Battisti; Centro Paraplegici Ospedale di Ostia: DA Fletzer, M Magnini; Centro Medico Cassano Murge, IRCCS, Cassano Murge (BA): R Nardulli, S Calabrese, E Lo Savio; Unità Spinale, Ospedale Careggi, Firenze: S Aito; Casa di Cura ‘Luce sul Mare’, Igea Marina: A Battistini, L Betti; Centro di Riabilitazione ‘Villa Beretta’, Ospedale Valduce, Costamasnaga: N Cellotto, A Lissoni, M Cazzaniga, F Molteni, L Suardi; Ospedale di Riabilitazione di Longone al Segrino, Longone al Segrino: M Almici; Sezione Mielolesi, Magenta: Magnaghi, A Zanollo, MG Zucchi, Tagliabue, P Politi; U.O.R.R.F. Ospedale Civile, Legnano: G Alberti; Istituto di Terapia Fisica e Riabilitazione, Milano: T Redaelli, E Radaelli, C Gallo, F Santagostini; Divisione Paraplegici, CTO, Milano: A Bava, CM Borghi; SRRF Ospedale di Bergamo, Sezione Mozzo, Mozzo: I Ghislandi, M Ceravolo, G Molinero; Centro di Riabilitazione ‘S Stefano’, P Potenza Picena: M Menichetti, M Vallasciani, M Rabuini, G Leone, S Spurio; Servizio Riabilitazione Ortopedica, Padova: D Primon, M Ortolani, Arrigo Baldo, M Gulgelmetto; Ospedale Casati, Passirana di Rho, Passirana di Rho: M Taricco, Ranieri, R Adone, S Di Carlo, A Ferrari, MG Maringelli; Centro Medico Montescano, Pavia: C Pistarini, C Rampulla, A Contardi; Ospedale Villa Rosa, CRF, Pergine Valsugana: R Albertazzi, A Mosetti; Unità Spinale Unipolare, Ospedale Silvestrini, Perugia: MC Pagliacci, G Finali; Unità di Neuroriabilitazione Clinica neurologica Ospedale S Chiara, Pisa: G Stampacchia, B Rossi; SRRF Ospedale SM delle Croci, Ravenna: G Gatta, S Tibaldi, G Cortese; IRCCS Santa Lucia, Roma: G Scivoletto, V Castellano; Unità Spinale Unipolare CTO, Roma: V Santilli, Trigila, M Vinciguerra; Unità Spinale, Sondalo: E Occhi, F Gualzetti; Unità Spinale, Torino: D Loria, V Filipello, S Negri, L Olino; U.O. di Riabilitazione Intensiva Neuromotoria, Trevi: S Baratta, M Zampolini; Centro di Riabilitazione, Trieste: P Di Benedetto, R Piccinino; Istituto di Medicina Fisica e Riabilitazione, Udine: M Saccavini, L Lovati, A Zampa; Reparto di RRF Ospedale ‘Sacro Cuore–Don Calabria’, Negrar: Z Cordioli, G Salvi, R Avesani; UORRF Unita Spinale Ospedale San Bortolo, Vicenza: M Leucci, M Menarini; Centro di Recupero e Rieducazione Funzionale, Villanova d'Arda: S Lotta, D Nicolotti, R Bocchi; Clinica Villa delle Magnolie, Castel Morrone: N Avena, M Esposito, P Sabino, C Limardi; Istituto scienze neurologiche, Catania: A Reggio; Istituto Riabilitazione Neuromotoria, Mezzaselva di Roana: C Strazzabosco, C Guerriero.
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Pagliacci, M., Celani, M., Spizzichino, L. et al. Spinal cord lesion management in Italy: a 2-year survey. Spinal Cord 41, 620–628 (2003). https://doi.org/10.1038/sj.sc.3101521
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