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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2000 September;35(3):139-45

language: English

The management of spinal cord injury: a multi-centre prospective study

Celani M. G.

Servizio per le Malattie Cerebrovascolari, Dipartimento di Medicina A.USL 2 dell’Umbria, Ospedale Città del­la Pieve (Perugia)


BACKGROUND: The ­present two-­year ­study was con­duct­ed to ­shed ­light on the Italian ­health net­work ­involved in Spinal Cord Injury (SCI) and to extrap­o­late use­ful ­data to ­plan ser­vic­es and insti­tute pre­ven­tion pro­jects.
METHODS: Experimental ­design: pros­pec­tive mul­ti-cen­tre ­study. Setting: Acute ­care or reha­bil­i­ta­tion ­wards ­that admit­ted spi­nal ­cord ­injured ­patients. Patients: Spinal ­cord ­injured ­patients (trau­mat­ic or non trau­mat­ic) admit­ted con­sec­u­tive­ly. Intervention: ­none; an obser­va­tion­al ­study. Measures: we ­used the ­ASIA impair­ment ­scale as a meas­ure of neu­ro­log­i­cal impair­ments and com­pli­ca­tions, auton­o­my at dis­charge and des­ti­na­tion as out­come meas­ures of appro­pri­ate man­age­ment.
RESULTS: Data ­were col­lect­ed on 2210 admis­sions and re-admis­sions in the two-­year peri­od. There was a 2:1 ­ratio ­between trau­mat­ic and non trau­mat­ic SCI. Topping the ­list of caus­es of trau­mat­ic inju­ry ­were ­road acci­dents (52% car, motor­bike and bicy­cle or pedes­trian acci­dents). Work acci­dents rep­re­sent­ed 17% of all trau­mat­ic SCI. Data indi­cat­ed a “migra­tion” of ­patients ­from the south­ern to the cen­tral and north­ern ­parts of the coun­try, due to the non homo­ge­ne­ous dis­tri­bu­tion of cen­tres. As for ­first-admis­sions, ­which rep­re­sent­ed ­half of the ­total ­records (1114), the ­para/tet­ra­ple­gia ­ratio on admis­sion was 2:1, ­motor com­plete­ness (A+B ­ASIA impair­ment ­scale) ­involved 53% of the ­whole ­cohort, ­with ­more ­risk for trau­mat­ic ­lesions. More ­than one ­third of ­patients pre­sent­ed at ­least one com­pli­ca­tion (pres­sure ­sores in 24.2%) on admis­sion. Median ­time ­from the ­event to admis­sion was sig­nif­i­cant­ly long­er for non trau­mat­ic cas­es (28/49 ­days). Neurological improve­ment of at ­least one ­point ­ASIA impair­ment ­scale was record­ed in 27% of sub­jects, main­ly involv­ing inter­me­di­ate (B and C) ­grades. Patients ­were dis­charged ­with inter­mit­tent cath­et­er­isa­tion or ­self-cath­et­er­isa­tion in 46% of cas­es, but 9% main­tained a ure­thral ­long ­term ind­well­ing cath­e­ter. Bowel auton­o­my was record­ed in 64% ­patients. The feel­ing of depen­den­cy on dis­charge was even­ly dis­trib­ut­ed ­with clus­ters on cen­tral and ­extreme val­ues. On dis­charge 80.9% of the SCI sub­jects ­were ­able to ­return ­home.
CONCLUSIONS: This is the ­first ­large and pros­pec­tive ­study to ­yield infor­ma­tion ­about epi­dem­i­ol­o­gy and the ­care ­system of SCI in Italy. The resul­tant ­data can be use­ful for pre­ven­tion and set­ting up a homo­ge­ne­ous and effi­cient ­health net­work for com­pre­hen­sive SCI treat­ment and reha­bil­i­ta­tion. More com­plete and inter­est­ing ­data ­could be ­obtained ­from a lon­gi­tu­di­nal ­study.

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