title: Accuracy of diagnoses in patients with spinal cord injury referred to hospital rehabilitation departments.
abstract: BACKGROUND
  Establishing a comprehensive diagnosis, together with the implementation of evidence-based therapeutic methods, is a prerequisite for effective and safe rehabilitation. The purpose of the study was to evaluate the accuracy of referral diagnoses and identify the risk factors for diagnostic neglect in persons after spinal injury with neurological consequences (SINC) referred to rehabilitation departments in hospitals.
  
  
  METHODS
  Referral diagnoses were compared with tentative diagnoses established on admission in 350 randomly chosen patients with SINC admitted to a rehabilitation department between 1998 and 2011. The patients were divided into Group A of those admitted in 1998-2004 and Group B of those admitted in 2006-11 (175 subjects each). The patterns of and risk factors for inaccurate and deficient referral diagnoses (IDRD) were analyzed.
  
  
  RESULTS
  The rate of IDRD was 38.3% in Group A and 35.4% in Group B. The number of diagnoses where additional data were added after verification on admission was 111 in Group A and 129 in Group B. The most common deficiencies in referral diagnoses consisted in the failure to identify symptomatic urinary tract infections (49), heterotopic ossification (39), and pressure sores (32). The IDRD rate was significantly (p>0.05) higher in patients referred from hospitals, surgical departments, those with thoracic spine lesions, complete neurological deficits, and those with at least two co-morbidities or concomitant injuries. Median time between SINC and admission for rehabilitation was longer in subjects with accurate referral diagnoses (180 days) compared with the IDRD group (54 days). Age, gender and cause of SINC did not correlate with IDRD.
  
  
  CONCLUSIONS
  Risk factors for IDRD in SINC patients include complete neurological deficit, short time elapsing from SINC, referral from a hospital, referral from a surgical department, thoracic spinal lesion, and multiple co-morbidities.
authors.affiliation: Department of Rehabilitation, Medical University of Warsaw. pited@esculap.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Tederko
authors.forename: Marek
authors.initials: M
authors.lastname: Krasuski
authors.forename: Barbara
authors.initials: B
authors.lastname: Dobies
mesh_terms: D015897:Comorbidity; D003951:Diagnostic Errors / Q000145:classification; D005260:Female; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D009999:Ossification, Heterotopic / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D014552:Urinary Tract Infections / Q000453:epidemiology