Peter Wayne New1, Ronald K Reeves2, Éimear Smith3, Andrea Townson4, Inge Eriks-Hoogland5, Anupam Gupta6, Belci Maurizio7, Giorgio Scivoletto8, Marcel W Post9. 1. Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia; Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Melbourne, VIC, Australia. Electronic address: p.new@cgmc.org.au. 2. Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN. 3. National Rehabilitation and Mater Misericordiae University Hospitals, Dublin, Ireland. 4. GF Strong Rehabilitation Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, Canada. 5. Swiss Paraplegic Research, Swiss Paraplegic Centre, Nottwil, Switzerland. 6. Neurological Rehabilitation Department, National Institute of Mental Health and Neurological Sciences, Bangalore, India. 7. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK. 8. Institute of Hospitalization and Scientific Care (IRCCS) Fondazione S. Lucia, Rome, Italy. 9. Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands.
Abstract
OBJECTIVE: To describe and compare epidemiologic characteristics of patients with spinal cord dysfunction admitted to spinal rehabilitation units (SRUs) in 9 countries (Australia, Canada, Italy, India, Ireland, The Netherlands, Switzerland, United Kingdom, and United States). DESIGN: Retrospective multicenter open-cohort case series. SETTING: SRUs. PARTICIPANTS: Patients (N=956) with initial onset of spinal cord dysfunction consecutively admitted between January 1, 2008, and December 31, 2010. Median age on admission was 59 years (interquartile range [IQR], 46-70), and 60.8% of patients were men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic characteristics (eg, age, sex), time frame over which clinical symptoms of spinal cord dysfunction developed, etiology, length of stay in hospital, level of lesion and American Spinal Injury Association Impairment Scale (AIS) grade, discharge destination, and inpatient mortality. RESULTS: The time frame of onset of spinal cord dysfunction symptoms was as follows: ≤1 day (28.5%); ≤1 week (13.8%); >1 week but ≤1 month (10.5%), and >1 month (47.2%). Most common etiologies were degenerative conditions (30.8%), malignant tumors (16.2%), ischemia (10.9%), benign tumors (8.7%), and bacterial infections (7.1%). Most patients (72.3%) had paraplegia. The AIS grade on SRU admission was grade A in 14%, grade B in 6.5%, grade C in 24%, grade D in 52.4%, grade E in 0.2%, and missing in 2.9%. AIS grade significantly improved by discharge (z=-10.1, P<.0001). Median length of stay in the SRU was 46.5 days (IQR, 17-89.5). Most (80.5%) patients were discharged home. Differences between countries were found for most variables. CONCLUSIONS: This international study of spinal cord dysfunction showed substantial variation of etiology, demographic, and clinical characteristics across countries. Further research, including multiple centers per country, are needed to separate country effects from center effects.
OBJECTIVE: To describe and compare epidemiologic characteristics of patients with spinal cord dysfunction admitted to spinal rehabilitation units (SRUs) in 9 countries (Australia, Canada, Italy, India, Ireland, The Netherlands, Switzerland, United Kingdom, and United States). DESIGN: Retrospective multicenter open-cohort case series. SETTING: SRUs. PARTICIPANTS: Patients (N=956) with initial onset of spinal cord dysfunction consecutively admitted between January 1, 2008, and December 31, 2010. Median age on admission was 59 years (interquartile range [IQR], 46-70), and 60.8% of patients were men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic characteristics (eg, age, sex), time frame over which clinical symptoms of spinal cord dysfunction developed, etiology, length of stay in hospital, level of lesion and American Spinal Injury Association Impairment Scale (AIS) grade, discharge destination, and inpatient mortality. RESULTS: The time frame of onset of spinal cord dysfunction symptoms was as follows: ≤1 day (28.5%); ≤1 week (13.8%); >1 week but ≤1 month (10.5%), and >1 month (47.2%). Most common etiologies were degenerative conditions (30.8%), malignant tumors (16.2%), ischemia (10.9%), benign tumors (8.7%), and bacterial infections (7.1%). Most patients (72.3%) had paraplegia. The AIS grade on SRU admission was grade A in 14%, grade B in 6.5%, grade C in 24%, grade D in 52.4%, grade E in 0.2%, and missing in 2.9%. AIS grade significantly improved by discharge (z=-10.1, P<.0001). Median length of stay in the SRU was 46.5 days (IQR, 17-89.5). Most (80.5%) patients were discharged home. Differences between countries were found for most variables. CONCLUSIONS: This international study of spinal cord dysfunction showed substantial variation of etiology, demographic, and clinical characteristics across countries. Further research, including multiple centers per country, are needed to separate country effects from center effects.
Authors: Marcel W M Post; Janneke Nachtegaal; Sacha A van Langeveld; Maureen van de Graaf; Willemijn X Faber; Ellen H Roels; Coen A M van Bennekom Journal: Top Spinal Cord Inj Rehabil Date: 2018
Authors: Peter Wayne New; Sara J T Guilcher; Susan B Jaglal; Fin Biering-Sørensen; Vanessa K Noonan; Chester Ho Journal: Top Spinal Cord Inj Rehabil Date: 2017