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Online ISSN 1973-9095
SPINAL CORD INJURIES
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.