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Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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ORIGINAL ARTICLES SPINAL CORD INJURIES
Europa Medicophysica 2000 Settembre;35(3):115-21
Rehospitalization of patients with spinal cord injuries. Health-care needs during the clinically stable phase
Pagliacci M. C.
Azienda Ospedaliera - Perugia, Ospedale “Silvestrini”, San Sisto, Perugia, Unità Spinale Unipolare
BACKGROUND: Herein we present the first analysis of the results concerning the recording of readmissions of clinically stable spinal cord injured (SCI) patients during the two years of the GISEM study. The presentation draws particular attention to aspects related to patients’ main needs as suggested by the principal causes of readmission and the other concomitant complications; patients’ geographical movements; indirectly evaluated health-related resources spent as quantification of readmissions; complications; and length of stay.
METHODS: a) Experimental design: a prospective multi-centre study. b) Setting: Acute care or rehabilitation wards that admitted SCI patients. c) Patients: A consecutive series of spinal cord injured patients (traumatic or non traumatic). d) Intervention: none; observational study. c) Measures: the ASIA impairment scale as a measure of neurological impairments and complications, degree of autonomy at discharge and destination as outcome measures of appropriate management.
RESULTS: Almost half the records of the SCI patients requiring hospitalisation during the study period concerned readmissions (1096/2210).There was a migration of patients from the southern to the central and northern regions. Patients’ characteristics at readmission were similar to those of the first admission group except for motor completeness with a lesser risk found in the latter group (OR 0.64, Cl 0.54-0.76). The principal reasons for readmission were unexpected: physiotherapy courses were the most frequent (33.2%) followed by urological complications (20.2%). Pressure sores represented a considerable proportion of the reasons for re-hospitalisation (9.3%). Mean length of stay (LoS) was 42 days (median 28 days) and was related to the reason for readmission with pressure sores and physiotherapy courses accounting for the longest LoS, and urological complications for the shortest. Group B centres were significantly more involved in physiotherapy courses related readmissions, group A centres in urological complications and pressure sores. Discharge destination was the patient’s home in 89%.
CONCLUSIONS: Patients’ requirements must be considered in planning services for SCI assistance in Italy and detailed to better allocate resources. Focussed follow-up and expert problem solving processes could avoid inappropriate admissions.