Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.
OBJECTIVE
To examine the frequency and reasons for rehospitalization in persons with acute traumatic spinal cord injury (SCI) during follow-up years and to examine the association between rehospitalization and demographics, neurologic category, payer sources, length of stay (LOS), discharge motor FIM instrument score, and discharge residence.


METHODS
Survey design with analysis of cross-sectional data.


METHODS
Model Spinal Cord Injury Systems (MSCIS) centers.


METHODS
Data for 8668 persons with SCI from 16 MSCIS centers entered in the National Spinal Cord Injury Statistical Center database between 1995 and 2002.


METHODS
Not applicable.


METHODS
MSCIS Forms I and II were used to identify the annual incidence, medical complications, and etiologies of rehospitalizations reported at 1-, 5-, 10-, 15-, and 20-year follow-ups.


RESULTS
The leading cause of rehospitalization was diseases of the genitourinary system, including urinary tract infections (UTIs). Diseases of the respiratory system tended to be more likely in patients with tetraplegia (C1-8 American Spinal Injury Association [ASIA] grades A, B, C); whereas patients with paraplegia (T1-S5 ASIA grades A, B, C) were more likely to be rehospitalized for pressure ulcers. The rate of rehospitalization was significantly higher at year 1, 5, and 20 for those who were discharged to a skilled nursing facility after acute rehabilitation. Lower motor score using the FIM was predictive of rehospitalization (P=.000). The average LOS per rehospitalization at the year-5 follow-up was approximately 12 days, which is lower than in past MSCIS reports.


CONCLUSIONS
Despite improvements in SCI medical management, rehospitalization rates remain high, with an increased incidence in conditions associated with the genitourinary system (including UTIs), respiratory complications (including pneumonia), and diseases of the skin (including pressure ulcers). Acutely injured patients need close follow-up to reduce morbidity and rehospitalizations.
Cardenas
Diana D
DD
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA. dianamac@u.washington.edu
Hoffman
Jeanne M
JM
Kirshblum
Steven
S
McKinley
William
W
D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018579:Patient Selection; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology