title: Incidence of acute care adverse events and long-term health-related quality of life in patients with TSCI.
abstract: BACKGROUND
  Adverse events (AEs) with significant resultant morbidity are common during the acute hospital care of patients with traumatic spinal cord injury (TSCI). The Rick Hansen SCI Registry (RHSCIR) collects Canada-wide data on patients with TSCI, such as sociodemographic, injury, diagnosis, intervention, and health outcome details. These data contribute to an evidence base for informing best practice and improving SCI care. As the RHSCIR captures data on patients from prehospital to community phases of care, it is an invaluable resource for providing information on health outcomes resulting from TSCI, including outcomes related to AEs.
  
  
  OBJECTIVE
  To determine the incidence and types of AEs occurring in patients with TSCI during acute care and the impact on length of stay (LOS) and health-related quality of life (HRQOL).
  
  
  METHODS
  Prospective cohort study at an academic quaternary referral center.
  
  
  METHODS
  Patients with TSCI discharged from our institution between 2008 and 2010 were identified using the RHSCIR. The RHSCIR includes patients admitted to one of the participating centers across Canada, who have been clinically diagnosed with an acute TSCI or classified as AIS A, B, C, D, or cauda equina.
  
  
  METHODS
  Acute-phase LOS and HRQOL were assessed for impact resulting from the number and type of AEs experienced. Health-related quality of life was determined using the short-form 36 (SF-36) physical and mental component summary scores and functional independence measure.
  
  
  METHODS
  Data related to patients' injury, diagnoses, hospital admission, and SF-36 scores were obtained from the local RHSCIR. Data on intra-, pre-, and postoperative AEs were collected prospectively using the Spine Adverse Events Severity System data collection system, documenting all AEs experienced by each patient. Multivariate analyses were performed to determine whether patient and injury characteristics were associated with the number and type of AEs experienced and whether these were associated with LOS and HRQOL determined on follow-up.
  
  
  RESULTS
  One hundred seventy-one patients with TSCI were included, 81.3% were men and mean age at injury was 47.2±20.3 years. Adverse events occurred in 77.2% of patients, 14.6% experienced an intraoperative and 73.7% experienced a pre/postoperative event. The most frequent pre/postoperative AEs were urinary tract infections (UTIs) (32.2%), pneumonias (32.8%), neuropathic pain (15.2%), decubitus ulcers (14.6%), and delirium (18.7%). Length of stay was significantly affected by decubitus ulcers, delirium, pneumonias, and UTIs (p<.01), increasing 1.7 (UTIs) to 2.2 (decubitus ulcers) times compared with patients without the specific AEs. Health-related quality of life was not affected by acute care AEs but rather those identified at 1-year follow-up.
  
  
  CONCLUSIONS
  This prospective study found that more than 77% of patients with TSCI sustain an AE during acute hospital care, significantly higher than previously reported. We demonstrate the utility of a dedicated AE collection system and the effect of these events on health status.
authors: Division of Spine, Department of Orthopedics, University of British Columbia, #6100, 818 W. 10th Ave., Vancouver, British Columbia, Canada V5Z 1M9. Electronic address: john.street@vch.ca.
authors: John T
authors: JT
authors: Street
authors: Division of Spine, Department of Orthopedics, University of British Columbia, #6100, 818 W. 10th Ave., Vancouver, British Columbia, Canada V5Z 1M9; Rick Hansen Institute, Vancouver, Blusson Spinal Cord Center, 818 W. 10th Ave., British Columbia, Canada V5Z 1M9.
authors: Vanessa K
authors: VK
authors: Noonan
authors: Rick Hansen Institute, Vancouver, Blusson Spinal Cord Center, 818 W. 10th Ave., British Columbia, Canada V5Z 1M9.
authors: Antoinette
authors: A
authors: Cheung
authors: Division of Spine, Department of Orthopedics, University of British Columbia, #6100, 818 W. 10th Ave., Vancouver, British Columbia, Canada V5Z 1M9.
authors: Charles G
authors: CG
authors: Fisher
authors: Division of Spine, Department of Orthopedics, University of British Columbia, #6100, 818 W. 10th Ave., Vancouver, British Columbia, Canada V5Z 1M9; Rick Hansen Institute, Vancouver, Blusson Spinal Cord Center, 818 W. 10th Ave., British Columbia, Canada V5Z 1M9.
authors: Marcel F
authors: MF
authors: Dvorak
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D005260:Female; D006304:Health Status; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000601:surgery*
keywords: Adverse events; Quality of life; Traumatic spinal cord injury