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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):147-53
The management of spinal cord injury in Italy: a multi-centre prospective study
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.