ORIGINAL ARTICLES  SPINAL CORD INJURIES Free access

Europa Medicophysica 2000 September;35(3):139-45

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

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

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.