title: Outcomes of outpatient visits for acute respiratory illness in veterans with spinal cord injuries and disorders.
abstract: 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.
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, Hines, Illinois 60141, USA.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Nayna
authors.initials: N
authors.lastname: Patel
authors.forename: Vishesh K
authors.initials: VK
authors.lastname: Kapur
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: 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