The importance of verifying diagnosis in patients with spinal cord injury hospitalized in a rehabilitation department.

Background. According to Annex 7 to Resolution no. 226/2003, the National Health Fund does not cover the costs of diagnostic procedures performed in rehabilitation departments. Everyday clinical practice shows that the availability of imaging studies and specialized laboratory tests is often crucial for effective and safe patient management. The purpose of our research was to analyze the need for diagnostic procedures and verification of referral diagnosis in patients with spinal cord injury admitted to a rehabilitation department. Material and methods. We studied 175 patients (134 males and 41 females, 16 to 75 years of age, mean age 35.2 years) admitted with a diagnosis of spinal cord injury to the Rehabilitation Department of the Warsaw Medical University in the period from 1998 to 2004. Referral diagnoses were compared to the diagnoses established after examination on admission to our Department (verified diagnoses). Results. In 67 patients (38.3%) the referral diagnosis differed from the verified diagnosis. The most frequent new diagnoses included: myositis ossificans: 22 cases (12.6%), decubitus ulcers: 14 cases (8.0%); other trophic skin lesions: 9 cases (5.4%) and undiagnosed concomitant injuries: 5 cases (2.9%). 13 patients (7.5%) were disqualified from further rehabilitation and referred for surgical treatment. Conclusions. 38.3% of our patients with spinal cord injury admitted for rehabilitation had an incorrect referral diagnosis. Legislative decisions limiting the availability of diagnostic procedures at rehabilitation departments lead to decreased health care quality. Spinal cord injury patients admitted for rehabilitation require verification of the referral diagnoses, preferably by the staff of the rehabilitation department.