title: Current trends in venous thromboembolism among persons hospitalized with acute traumatic spinal cord injury: does early access to rehabilitation matter?
abstract: OBJECTIVE
  To determine the incidence of venous thromboembolism (VTE) among patients with traumatic spinal cord injury (TSCI) in acute care settings that is attributable to extended length of stay (LOS), insurance status, and access to rehabilitation.
  
  
  METHODS
  Population-based, retrospective cohort study.
  
  
  METHODS
  Levels I through III and undesignated trauma centers.
  
  
  METHODS
  Patients with acute TSCI (N=3389) discharged from all acute care hospitals in South Carolina from 1998 through 2009, and a representative sample of patients with TSCI (n=186) interviewed 1 year later.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  VTE while in acute care.
  
  
  RESULTS
  Annual incidence of TSCI is 67.2 per million in the state of South Carolina, while the cumulative incidence of VTE is 4.1%. Patients with TSCI who developed VTE were nearly 4 times more likely (odds ratio [OR], 3.98; 95% confidence interval [CI], 2.57-6.17) to have been those who stayed 12 days or longer in acute care after adjusting for covariates. The adjusted mean LOS in acute care was 32.0 days (95% CI, 27.7-37.2) for patients with TSCI who had indigent insurance versus 11.3 days (95% CI, 4.9-17.6) for Medicare, and 18.5 days (95% CI, 14.5-22.5) for commercial insurance after adjusting for VTE, disposition, and year of discharge. Only 20% of the persons under indigent care received rehabilitation from accredited rehabilitation facilities in contrast to 60% under commercial insurance.
  
  
  CONCLUSIONS
  Fewer patients with TSCI under indigent care received postacute rehabilitation compared with Medicare or commercial insurance. Insurance status remains a major barrier to timely transfer to rehabilitation, leading to protracted LOS in acute care with increased risk of VTE.
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. selassie@musc.edu
authors.forename: Anbesaw W
authors.initials: AW
authors.lastname: Selassie
authors.forename: Abhay
authors.initials: A
authors.lastname: Varma
authors.forename: Lee L
authors.initials: LL
authors.lastname: Saunders
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D019458:Insurance Coverage; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D013022:South Carolina / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology*