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SPINAL CORD INJURIES
Taricco M. 1, Adone R. 1, Di Carlo S. 1, Ferrari A. 1, Pistarini C. 2, Spizzichino L. 3
1 Rehabilitation Unit, Ospedale di Passirana di Rho;
2 Unità Spinale Fondazione Salvatore Maugeri, Clinica del Lavoro e della Riabilitazione, IRCCS, Istituto Scientifico di Montescano;
3 Dipartimento della Prevenzione, Ministero della Sanità
BACKGROUND: There is evidence that spinal cord injury (SCI) care systems that provide treatment in all phases of the disease using a multidisciplinary approach will lead to improved outcomes, specifically: a lower incidence of pressure sores, reduced mortality and shorter lengths of stay. The aim of the present study was to describe the structural and organisational characteristics of Italian SCI centres within the context of an Italian epidemiological study on SCI (GISEM).
METHODS: The 37 centres participating in the GISEM study were sent a semi-structured questionnaire investigating: timing of care provided by the centre, type of treatment provided and organisation modality, and management of complications. Analysis of results (performed under blinded conditions) was stratified by the type of centre. Chi square, odds ratio and ANOVA for quantitative variables were used for the statistical analysis.
RESULTS: The centres were divided into three groups: a) 7 Spinal Cord Units (SUs) able to provide early care, global rehabilitation management and complete management of complications; b) 25 Rehabilitation Centres (RCs) that were unable to provide acute care; c) Services (Ss) providing only acute care. The time lapse from the acute event to admission was significantly shorter for the SUs compared with the RCs (median: 24 days vs 38 days) even though this was still a high figure for the SUs. The overall length of stay was significantly higher for the SUs compared with the RCs (median: 140 days vs 84 days). The SUs showed a higher percentage of home discharges than the RCs, which instead had a higher percentage of discharges to other wards. Additionally, the SUs showed a lower rate of pressure sores at discharge than the RCs. Comparison of the “dedicated” and “mixed” wards confirmed these results. Moreover, more complications were reported during stays in the “dedicated”wards.
CONCLUSIONS: In Italy, SCI rehabilitation facilities are strikingly heterogeneous. Acute management is still a critical issue both for the uneven territorial distribution of the rehabilitation centres and their inadequate integration with the emergency phase. Specialised care systems with a global multidisciplinary approach are more effective in improving patients’ outcomes at discharge.