Abstract
Study design:
Retrospective database review.
Objective:
To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital.
Background:
Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital.
Methods:
Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared.
Results:
Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (P<0.001).
Conclusion:
Acute care in organized SCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.
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References
Berkowitz M, O’leary PK, Kruse DL, Harvey C . Direct costs of spinal injury. In: Berkowitz M (ed.) Spinal Cord Injury: An Analysis of Medical and Social Costs. Demos Medical Publishing: New York, 1998, pp 107.
National Spinal Cord Injury Statistical Center. Spinal Cord Injury: Facts and Figures at a Glance 2009. The University of Alabama: Birmingham, AL, 2009.
Stover SL, DeVivo MJ, Go BK . History, implementation, and current status of the National Spinal Cord Injury Database. Arch Phys Med Rehabil 1999; 80: 1365–1371.
DeVivo MJ, Kartus PL, Stover SL, Fine PR . Benefits of early admission to an organised spinal cord injury care system. Paraplegia 1990; 28: 545–555.
Oakes DD, Wilmot CB, Hall KM, Sherck JP . Benefits of early admission to a comprehensive trauma center for patients with spinal cord injury. Arch Phys Med Rehabil 1990; 71: 637–643.
Donovan WH, Carter RE, Bedbrook GM, Young JS, Griffiths ER . Incidence of medical complications in spinal cord injury: patients in specialised, compared with non-specialised centres. Paraplegia 1984; 22: 282–290.
Yarkony GM, Bass LM, Keenan III V, Meyer Jr PR . Contractures complicating spinal cord injury: incidence and comparison between spinal cord centre and general hospital acute care. Paraplegia 1985; 23: 265–271.
Heinemann AW, Yarkony GM, Roth EJ, Lovell L, Hamilton B, Ginsburg K et al. Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs general hospital short-term care. Arch Neurol 1989; 46: 1098–1102.
National Pressure Ulcer Advisory Panel. Pressure Ulcer Stages Revised by NPUAP. NPUAP: Washington, DC, 2007.
National Spinal Cord Injury Statistical Center. Spinal Cord Injury Facts & Figures at a Glance 2008. University of Alabama: Birmingham, AL, 2008.
Eastwood EA, Hagglund KJ, Ragnarsson KT, Gordon WA, Marino RJ . Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury—1990–1997. Arch Phys Med Rehabil 1999; 80: 1457–1463.
Chen D, Apple Jr DF, Hudson LM, Bode R . Medical complications during acute rehabilitation following spinal cord injury—current experience of the Model Systems. Arch Phys Med Rehabil 1999; 80: 1397–1401.
Mains C, Scarborough K, Bar-Or R, Hawkes A, Huber J, Bourg P et al. Staff commitment to trauma care improves mortality and length of stay at a level I trauma center. J Trauma 2009; 66: 1315–1320.
Zhu HF, Newcommon NN, Cooper ME, Green TL, Seal B, Klein G et al. Impact of a stroke unit on length of hospital stay and in-hospital case fatality. Stroke 2009; 40: 18–23.
Rutges JP, Oner FC, Leenen LP . Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome. Eur Spine J 2007; 16: 579–587.
Marshall LF, Knowlton S, Garfin SR, Klauber MR, Eisenberg HM, Kopaniky D et al. Deterioration following spinal cord injury. A multicenter study. J Neurosurg 1987; 66: 400–404.
Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine (Phila, PA, 1976) 1997; 22: 2609–2613.
Duh MS, Shepard MJ, Wilberger JE, Bracken MB . The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment. Neurosurgery 1994; 35: 240–248;discussion 248–249.
McKinley W, Meade MA, Kirshblum S, Barnard B . Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil 2004; 85: 1818–1825.
Marciniak CM, Heinemann AW, Monga T . Changes in medical stability upon admission to a rehabilitation unit. Arch Phys Med Rehabil 1993; 74: 1157–1160.
Acknowledgements
We acknowledge Benjamin Leiby, PhD for his assistance with the statistical analyses.
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Ploumis, A., Kolli, S., Patrick, M. et al. Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center. Spinal Cord 49, 411–415 (2011). https://doi.org/10.1038/sc.2010.132
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DOI: https://doi.org/10.1038/sc.2010.132
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