title: Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury.
abstract: BACKGROUND
  People with traumatic spinal cord injury (SCI) face complex challenges in their care, recovery and life. Secondary conditions can develop to involve many body systems and can impact health, function, quality of life, and community participation. These secondary conditions can be costly, and many are preventable. The aim of this study was to describe the type and direct costs of secondary conditions requiring readmission to hospital, or visit to an emergency department (ED), within the first two years following traumatic spinal cord injury (SCI).
  
  
  METHODS
  A retrospective cohort study using population-level linked data from hospital ED and admission datasets was undertaken in Victoria, Australia. The incidence and direct treatment costs of readmission to hospital and ED visit within 2-years post-injury for secondary conditions related to SCI were measured for the 356 persons with traumatic SCI with a date of injury from 2008 to 2011.
  
  
  RESULTS
  Of the 356 cases, 141 (40%) experienced 366 (median 2, range 1-11) readmissions to hospital for secondary conditions. 95 (27%) visited an ED at least once, within two years of injury for a secondary condition. The cost of hospital readmissions was AUD$5,553,004 and AUD$87,790 for ED visits. The mean±SD cost was AUD$15,172±$20,957 per readmission and AUD$670±$198 per ED visit. Urological conditions (e.g. urinary tract infection) were most common, followed by pressure areas/ulcers for readmissions, and fractures in the ED.
  
  
  CONCLUSIONS
  Hospitalisation for complications within two years of traumatic SCI was common and costly in Victoria, Australia. Improved bladder and pressure area management could result in substantial morbidity and cost savings following SCI.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Farr Institute-CIPHER, Swansea University Medical School, Swansea University, Swansea, United Kingdom. Electronic address: belinda.gabbe@monash.edu.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nunn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011322:Primary Prevention / Q000191:economics / Q000458:organization & administration*; D011788:Quality of Life; D012140:Respiratory Tract Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D014570:Urologic Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Complications; Costs; Emergency department visit; Readmission; Secondary conditions; Traumatic spinal cord injury