International retrospective comparison of inpatient rehabilitation for patients with spinal cord dysfunction epidemiology and clinical outcomes.
OBJECTIVE
To describe and compare epidemiologic characteristics of patients with spinal cord dysfunction admitted to spinal rehabilitation units (SRUs) in 9 countries (Australia, Canada, Italy, India, Ireland, The Netherlands, Switzerland, United Kingdom, and United States).


METHODS
Retrospective multicenter open-cohort case series.


METHODS
SRUs.


METHODS
Patients (N=956) with initial onset of spinal cord dysfunction consecutively admitted between January 1, 2008, and December 31, 2010. Median age on admission was 59 years (interquartile range [IQR], 46-70), and 60.8% of patients were men.


METHODS
Not applicable.


METHODS
Demographic characteristics (eg, age, sex), time frame over which clinical symptoms of spinal cord dysfunction developed, etiology, length of stay in hospital, level of lesion and American Spinal Injury Association Impairment Scale (AIS) grade, discharge destination, and inpatient mortality.


RESULTS
The time frame of onset of spinal cord dysfunction symptoms was as follows: ≤1 day (28.5%); ≤1 week (13.8%); >1 week but ≤1 month (10.5%), and >1 month (47.2%). Most common etiologies were degenerative conditions (30.8%), malignant tumors (16.2%), ischemia (10.9%), benign tumors (8.7%), and bacterial infections (7.1%). Most patients (72.3%) had paraplegia. The AIS grade on SRU admission was grade A in 14%, grade B in 6.5%, grade C in 24%, grade D in 52.4%, grade E in 0.2%, and missing in 2.9%. AIS grade significantly improved by discharge (z=-10.1, P<.0001). Median length of stay in the SRU was 46.5 days (IQR, 17-89.5). Most (80.5%) patients were discharged home. Differences between countries were found for most variables.


CONCLUSIONS
This international study of spinal cord dysfunction showed substantial variation of etiology, demographic, and clinical characteristics across countries. Further research, including multiple centers per country, are needed to separate country effects from center effects.
Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia; Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Melbourne, VIC, Australia. Electronic address: p.new@cgmc.org.au.
Peter Wayne
PW
New
Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN.
Ronald K
RK
Reeves
National Rehabilitation and Mater Misericordiae University Hospitals, Dublin, Ireland.
Éimear
É
Smith
GF Strong Rehabilitation Centre, Vancouver, BC, Canada; University of British Columbia, Vancouver, Canada.
Andrea
A
Townson
Swiss Paraplegic Research, Swiss Paraplegic Centre, Nottwil, Switzerland.
Inge
I
Eriks-Hoogland
Neurological Rehabilitation Department, National Institute of Mental Health and Neurological Sciences, Bangalore, India.
Anupam
A
Gupta
National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.
Belci
B
Maurizio
Institute of Hospitalization and Scientific Care (IRCCS) Fondazione S. Lucia, Rome, Italy.
Giorgio
G
Scivoletto
Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands.
Marcel W
MW
Post
D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D004185:Disability Evaluation; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D010264:Paraplegia / Q000453:epidemiology / Q000534:rehabilitation; D010343:Patient Admission; D012044:Regression Analysis; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation*
Delivery of health care; Epidemiology; Outcome and process assessment (health care); Rehabilitation; Spinal cord diseases