Outcomes of outpatient visits for acute respiratory illness in veterans with spinal cord injuries and disorders.
OBJECTIVE
Respiratory complications are a leading cause of death in persons with spinal cord injuries and disorders (SCI&D). We examined same-day and 60-day hospitalizations and 60-day mortality after acute respiratory illness (ARI) outpatient visits.


METHODS
A longitudinal study was conducted of 8775 ARI visits in the Veterans Health Administration (VA) (October. 1997-September 2002) by persons with SCI&D. ARIs included upper respiratory infections (URI), acute bronchitis, pneumonia, and influenza (P&I).


RESULTS
URIs accounted for almost half of all (49%) visits. A total of 14.9% of patients with ARIs were hospitalized the same day; 30.8% were hospitalized within 60 days. Predictors of hospitalization included diagnosis of either P&I or acute bronchitis, comorbid illness, level of injury, age, and VA SCI center visit. Overall 60-day mortality was 2.9% but was 7.9% for pneumonia. Mortality was related to diagnosis (P&I: odds ratio [OR] = 9.80, 95% confidence interval [CI]: 6.27-13.33; acute bronchitis: OR = 2.00, 95% CI: 1.08-2.93), age (65+: OR = 3.96, 95% CI: 2.23-5.70), and comorbid conditions (OR = 1.94, 95% CI: 1.43-2.46).


CONCLUSIONS
P&I and acute bronchitis were associated with increased VA hospitalization and mortality rates. The case fatality rate for pneumonia is higher for SCI&D than the general population. Level of injury predicted hospitalization but not death. Efforts to improve prevention and treatment of ARIs in persons with SCI&D are needed.
Weaver
Frances M
FM
Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, Illinois 60141, USA.
Smith
Bridget
B
Evans
Charlesnika T
CT
Kurichi
Jibby E
JE
Patel
Nayna
N
Kapur
Vishesh K
VK
Burns
Stephen P
SP
D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D044469:Racial Groups; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000453:epidemiology*; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs