Cynthia Thompson

The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients

Abstract Context/objective Traumatic spinal cord injuries (T-SCI) have a devastating impact and place a significant financial burden on the healthcare system. The incidence of T-SCI ranges from 10.4 to 83 cases per million and varies with age, sex, or geographical region. This study describes the epidemiology and demographic characteristics of patients treated for T-SCI in our region over 11 years. Design Retrospective cohort study. Setting Single Level-I trauma center in Québec, Canada. Participants Patients who sustained T-SCI between 1 April 2000 and 31 March 2011. Interventions None. Outcome measures Data concerning T-SCI patients was retrieved from the Québec Trauma Registry. Information on age, sex, trauma, level of injury, type and severity of neurological deficit (ASIA scale), and treatment was extracted. Annual, age-standardized rates of T-SCI were calculated and trends over time were examined. Results Eight hundred and thirty-one patients with T-SCI were identified. The incidence of T-SCI did not change over time but there was a 13-year increase in age between 2002 and 2010. More than 60% of patients aged 55 years or more were injured following a fall and 80% became tetraplegic. These patients were more likely to have central cord syndrome (CCS) and incomplete neurological injury, compared to younger patients. The incidence of CCS increased from 25 to 37% over 11 years. Conclusions The T-SCI population is aging and is more frequently sustaining injuries associated with CCS, incomplete neurological deficits and tetraplegia.

Does Timing of Surgery Affect Hospitalization Costs and Length of Stay for Acute Care following a Traumatic Spinal Cord Injury

Although there is a trend toward performing early surgery for traumatic spinal cord injury (SCI), it remains unclear whether this tendency leads to decreased costs and length of stay (LOS) for acute care. This study determined the impact of surgical timing on costs and LOS after a traumatic SCI. A total of 477 consecutive patients sustaining an acute traumatic SCI and receiving surgery at a level I trauma center were included. A general linear model was used to assess the relationship among costs, LOS, and surgical delay, while accounting for various sociodemographic and clinical covariables. The analysis was also repeated with surgical delay dichotomized within 24 h or later after the trauma. Mean costs and LOS for all patients were respectively 24,156 ± 17,244

Non-Neurological Outcomes after Complete Traumatic Spinal Cord Injury: The Impact of Surgical Timing

CAD and 35.0 ± 39.4 days. The costs of acute care hospitalization were related to the surgical delay between the trauma and the surgery, in addition to age, injury severity score (ISS), American Spinal Injury Association (ASIA) grade, and neurological level. LOS was associated with the surgical delay dichotomized into two groups (<24 vs. ≥24 h), as well as with age, ISS, ASIA grade, and neurological level. This study suggests that resource utilization in terms of costs and LOS for the acute hospitalization is decreased with early surgery after an acute traumatic SCI, particularly if the procedure is performed within 24 h following the trauma. Performing the surgery as early as possible when the patient is cleared for surgery could lower the financial burden on the healthcare system, while optimizing the neurological recovery.

Surgical management of patients following traumatic spinal cord injury: identifying barriers to early surgery in a specialized spinal cord injury center

It remains unclear whether the benefits of early surgical timing are significant in neurologically complete spinal cord injury (SCI). We wanted to compare the effects of early and late surgical timing on non-neurological outcomes in persons with traumatic complete SCI. All cases of traumatic complete SCI referred to a single institution between 2000 and 2011 were retrospectively reviewed. The occurrence of pneumonia, urinary tract infection (UTI), pressure ulcer (PU), and all other postoperative complications were recorded. Cost of acute hospitalization was calculated for each patient based on administrative data. Patients operated on within 24 h of the trauma were compared with patients operated on later than 24 h after the trauma. The effects of surgical timing on complication rate and cost of hospitalization were adjusted for potential confounding variables using multiple regression analyses. Fifty-five patients were operated on ≤ 24 h from injury and 142 were operated on >24 h from injury. Baseline demographic and clinical variables were comparable between the two groups. Pneumonia, UTI, and the presence of any complications were significantly higher in the group operated on >24 h post-trauma. Cost of hospitalization was higher among patients operated >24h post-trauma (≤ 24 h: 22,828

Costs and Length of Stay for the Acute Care of Patients with Motor-complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute Sci Center.

vs. >24 h: 29,714

Does the Acute Care Spinal Cord Injury Setting Predict the Occurrence of Pressure Ulcers at Arrival to Intensive Rehabilitation Centers

). Surgical timing >24 h was a predictor of pneumonia, UTI, total complications. and higher cost of hospitalization after controlling for other confounding variables. This study shows that surgical decompression and stabilization ≤ 24 h following a complete SCI may be a cost-effective strategy to reduce the postoperative complication rate.

Effectiveness of a multi‐layer foam dressing in preventing sacral pressure ulcers for the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress

Context/Objective: Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare-related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI. Design: Prospective cohort study. Setting: Single Level I trauma center in Québec, Canada. Participants: One hundred and forty-four patients who sustained a T-SCI. Interventions: None. Outcome measures: Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (<24 hours post-trauma) and late surgery, or LS (≥ 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS. Results: 93 patients had ES (15.6 ± 4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9 ± 30.9 hours; P < 10−3). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0 ± 3.0 hours vs 13.6 ± 17.0; P < 10−3) for the ES group, and the surgical plan was completed 17 hours faster (6.0 ± 4.0 hours vs 23.3 ± 23.6 hours; P < 10−3) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room. Conclusions: A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.

The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury

Objective Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. Design A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center. Results Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P < 10−3), and average costs were also higher (median, Canadian

The use of regression tree analysis for predicting the functional outcome following traumatic spinal cord injury

17,920.0 vs.

Quality of life in the subacute period following a cervical traumatic spinal cord injury based on the initial severity of the injury: a prospective cohort study

10,521.6; P = 0.004) for group 2, despite similar characteristics. Late transfer to the SCI center was the main predictive factor of longer LOS and increased costs. Conclusions Early admission to the SCI center was associated with shorter LOS and lower costs for patients sustaining tetraplegia. Early referral to an SCI center before surgery could lower the financial burden for the health care system. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Determine the optimal timing for transfer of individuals with cervical traumatic spinal cord injury (SCI) in order to decrease acute care resource utilization; (2) Determine benefits of a complete perioperative management in a specialized SCI center; and (3) Identify factors that may influence resource utilization for acute care following motor-complete tetraplegia. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.