title: The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury.
abstract: We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.
authors.affiliation: 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .|2 MD/PhD Training Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Squair
authors.affiliation: 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .|3 Rick Hansen Institute , Vancouver, British Columbia, Canada .
authors.forename: Barry A B
authors.initials: BA
authors.lastname: White
authors.affiliation: 4 Department of Paediatrics, Western University , Ottawa, Canada .
authors.forename: Grace I
authors.initials: GI
authors.lastname: Bravo
authors.affiliation: 5 Department of Kinesiology, McMaster University , Hamilton, Ontario, Canada .
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Martin Ginis
authors.affiliation: 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .|6 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .|7 GF Strong Rehabilitation Centre , Vancouver Health Authority, Vancouver, British Columbia, Canada .
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Krassioukov
mesh_terms: D020211:Autonomic Dysreflexia / Q000191:economics* / Q000209:etiology*; D002170:Canada; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications*
keywords: clinical management of central nervous system injury; spinal cord injury; traumatic spinal cord injury