ORIGINAL ARTICLES  SPINAL CORD INJURIES Free access

Europa Medicophysica 2000 September;35(3):147-53

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

Zampolini M.

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.