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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)
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Europa Medicophysica 2000 September;35(3):147-53

language: English

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

Zampolini M.

U.O. di Riabilitazione Intensiva Neuromotoria, ­AUSL 3 dell’Umbria - Perugia


BACKGROUND: The ­present two-­year ­study set out to ­shed ­light on the Italian ­health net­work ­involved in Spinal Cord Injury (SCI) and to extrap­o­late ­data for the plan­ning of ser­vic­es and pre­ven­tion strat­e­gies.
METHODS: Experimental ­design: A mul­ti-cen­tre pros­pec­tive ­study. Setting: Acute ­care or reha­bil­i­ta­tion ­wards ­that admit­ted spi­nal ­cord ­injured ­patients. Patients: Patients ­with trau­mat­ic spi­nal ­cord inju­ries (­TSCI) con­sec­u­tive­ly admit­ted. Intervention: None as ­this was an obser­va­tion­al ­study. Measures: The ­ASIA impair­ment ­scale as a meas­ure of neu­ro­log­i­cal impair­ment and com­pli­ca­tions, inde­pen­dence on dis­charge and dis­charge des­ti­na­tion as out­come meas­ures.
RESULTS: Data ­were col­lect­ed on 2210 admis­sions and read­mis­sions in the two ­year peri­od. The ­ratio ­between trau­mat­ic and non-trau­mat­ic caus­es of ­lesion was 2:1. The ­most com­mon ­cause of ­TSCI was a ­road traf­fic acci­dent (52% involv­ing ­cars, motor­cy­cles and bicy­cles or pedes­trians). Work-relat­ed acci­dents account­ed for 17% of all ­TSCI. Data indi­cat­ed the move­ment of ­patients ­from south­ern to cen­tral and north­ern ­parts of the coun­try due to the non homo­ge­ne­ous dis­tri­bu­tion of cen­tres. First-admis­sions rep­re­sent­ed ­half of the ­total ­records (1114): the ­para/tet­ra­ple­gia ­ratio on admis­sion was 2:1, ­motor com­plete­ness (A+B on the ­ASIA impair­ment ­scale) ­involved 53% of the glo­bal pop­u­la­tion, ­with ­more ­risk for trau­mat­ic ­lesions. More ­than one ­third of the ­patients pre­sent­ed at ­least one com­pli­ca­tion (pres­sure ­sores in 24.2%) on admis­sion. Median ­time ­from the ­event to admis­sion was sig­nif­i­cant­ly long­er for ­NTSCI (28/49 ­days). Neurological improve­ment of at ­least one ­point on the ­ASIA impair­ment ­scale was record­ed in 27% sub­jects, and main­ly ­involved inter­me­di­ate (B and C) ­grades. Patients ­were dis­charged ­with inter­mit­tent cath­et­er­isa­tion or ­self-cath­et­er­isa­tion in 46% cas­es, but 9% main­tained an 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 SCI sub­jects ­returned ­home.
CONCLUSIONS: This is the ­first ­large pros­pec­tive ­study to pro­vide infor­ma­tion ­about the epi­dem­i­ol­o­gy and man­age­ment of SCI in Italy. The resul­tant ­data ­will be use­ful for ­both pre­ven­tion strat­e­gies 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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