David Conradsson1,2, Julie Phillips3, Eugene Nizeyimana3, Chantal Hilliar3, Conran Joseph4,5. 1. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden. 2. Karolinska University Hospital, Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Stockholm, Sweden. 3. Faculty of Community and Health Sciences, Physiotherapy Department, University of the Western Cape, Cape Town, South Africa. 4. Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden. conran.joseph@ki.se. 5. Faculty of Community and Health Sciences, Physiotherapy Department, University of the Western Cape, Cape Town, South Africa. conran.joseph@ki.se.
Abstract
STUDY DESIGN: Population-based cohort study. OBJECTIVES: To determine non-modifiable and modifiable risk indicators of acute length of hospital stay (LOHS) after traumatic spinal cord injury (TSCI). SETTING: Government-funded hospitals within the City of Cape Town, South Africa. METHODS: Newly injured survivors of TSCI during a 1 year period were prospectively included. Non-modifiable (e.g., demographic factors and clinical characteristics) and modifiable risk indicators (e.g., clinical processes, timing of surgery, secondary complications) of prolonged LOHS (31 days) were determined using univariate and multivariable logistic regression analyses. RESULTS: Of the total population-based cohort of 145 individuals, 139 (96%) had valid LOHS data and were included in the analyses. Significant univariate non-modifiable risk indicators of LOHS were age, complete injury and vertebral injury, whereas modifiable risk indicators were delayed spinal surgery (>72 h) and the occurrence of any secondary complications, as well as specifically pressure ulcers, pneumonia and urinary tract infection. In the final multivariable model showing good fit and acceptable discrimination (AUC = 0.86), older age (OR: 1.04, 95% CI: 1.00-1.07), vertebral injury (OR: 3.18, 95% CI: 1.07-9.44), pneumonia (OR: 8.40, 95% CI: 2.76-25.55) and pressure ulcers (OR: 7.16, 95% CI: 2.54-20.22) remained significant independent factors. Only injury completeness was insignificant in the final model. CONCLUSIONS: Our findings shed light on the need of developing prevention programs for secondary complications to improve the quality and efficiency of acute SCI care in South Africa. SPONSORSHIP: The National Research Foundation of South Africa.
STUDY DESIGN: Population-based cohort study. OBJECTIVES: To determine non-modifiable and modifiable risk indicators of acute length of hospital stay (LOHS) after traumatic spinal cord injury (TSCI). SETTING: Government-funded hospitals within the City of Cape Town, South Africa. METHODS: Newly injured survivors of TSCI during a 1 year period were prospectively included. Non-modifiable (e.g., demographic factors and clinical characteristics) and modifiable risk indicators (e.g., clinical processes, timing of surgery, secondary complications) of prolonged LOHS (31 days) were determined using univariate and multivariable logistic regression analyses. RESULTS: Of the total population-based cohort of 145 individuals, 139 (96%) had valid LOHS data and were included in the analyses. Significant univariate non-modifiable risk indicators of LOHS were age, complete injury and vertebral injury, whereas modifiable risk indicators were delayed spinal surgery (>72 h) and the occurrence of any secondary complications, as well as specifically pressure ulcers, pneumonia and urinary tract infection. In the final multivariable model showing good fit and acceptable discrimination (AUC = 0.86), older age (OR: 1.04, 95% CI: 1.00-1.07), vertebral injury (OR: 3.18, 95% CI: 1.07-9.44), pneumonia (OR: 8.40, 95% CI: 2.76-25.55) and pressure ulcers (OR: 7.16, 95% CI: 2.54-20.22) remained significant independent factors. Only injury completeness was insignificant in the final model. CONCLUSIONS: Our findings shed light on the need of developing prevention programs for secondary complications to improve the quality and efficiency of acute SCI care in South Africa. SPONSORSHIP: The National Research Foundation of South Africa.
Authors: Hueiming Liu; Mohammad Sohrab Hossain; Md Shofiqul Islam; Md Akhlasur Rahman; Punam D Costa; Robert D Herbert; Stephen Jan; Ian D Cameron; Stephen Muldoon; Harvinder S Chhabra; Richard I Lindley; Fin Biering-Sorensen; Stanley Ducharme; Valerie Taylor; Lisa A Harvey Journal: Spinal Cord Date: 2020-06-15 Impact factor: 2.772