Abstract
This study examined the complications and costs of management of patients with acute spinal cord injury (ASCI) in a regional, multidisciplinary acute spinal cord injury unit (ASCIU). Data were available to compute length of stay (LOS) on 191 of the first 220 consecutive patients managed in this unit from 1974 to 1981. Specific formulae for assessing hospital and medical costs were developed based on a systems analysis approach. The statistical analysis included multiple regression analysis for determining the effect of the principal admission characteristics of ASCI patients, the main types of complications, and the methods of management. The effects of these variables on LOS, costs per day (CPD), and costs per stay (CPS) were determined.
Age at admission, sex, and cause of accident had no effect on costs. As expected, increasing severity of injury to the spinal cord and to the vertebral column caused a significant increase in the mean LOS and CPS, and increasing total trauma load resulted in a significant increase in LOS and CPS. The LOS was shorter for patients admitted sooner after trauma. Respiratory, gastrointestinal, thromboembolic and genitourinary complications and decubitus ulceration were all associated with marked increases in LOS and CPS. The annual mean CPS decreased dramatically during the period of the study from 1974-81 due mainly to a decrease in LOS. Multiple regression analysis showed that severity and level of the spinal column and spinal cord injury, and the presence of complications had the most significant effects on duration and cost of care. The study also suggests that a specialized, multidisciplinary regional unit for ASCI patients is associated with a reduction in LOS and cost of care.
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Kraus J F, Franti C E, Riggins R S, Richards D, Borhani N O (1975) Incidence of traumatic spinal cord lesions. J Chron Dis 28: 471–492.
Stripling T E (1990) The cost of SCI: the economic consequences of traumatic spinal cord injury. Paraplegia News. August: 50–54.
Charles E D, Fine P R, Stover S L, Wood T, Lott A F, Kronenfeld J (1978) The costs of spinal cord injury. Paraplegia 15: 302–310.
Kalsbeek W D, McLaurin R L, Harris B S H, Miller J D (1980) The National Head and Spinal Cord Injury Survey: major findings. J Neurosurg 53: S19–S31.
Webb S B, Berzins E, Wingardner T S, Lorenzi M E (1977/8) First year hospitalization costs for the spinal cord injured patient. Paraplegia 15: 311–318.
Tator C H, Rowed D W, Schwartz M L (1982) Sunnybrook cord injury scales for assessing neurological injury and neurological recovery. In: Tator CH, editor. Early Management of Acute Spinal Cord Injury. Raven Press, New York: 7–24.
Tator C H (1983) Spine-spinal cord relationships in spinal cord trauma. Clin Neurosurg 30: 479–494.
Baker S P, O'Neill B, Haddon W, Long W B (1974) The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14: 187–196.
Greenspan L, McLellan B A, Greig H (1985) Abbreviated injury scale and injury severity score: a scoring chart. J Trauma 25: 60–64.
Tator C H, Duncan E G, Edmonds V E, Lapczak L I, Andrews D F (1987) Comparison of surgical and conservative management in 208 patients with acute spinal cord injury. Can J Neurol Sci 14: 60–69.
Edmonds V E, Tator C H (1982) Coordination of a halo program for an acute spinal cord injury unit. In: Tator CH, editor. Early Management of Acute Spinal Cord Injury. Raven Press. New York: 263–271.
Bugaresti J M, Tator C H, Chin Sang H, Maggisano R, Szalai J P (1987) Continuous versus intermittent turning for treatment of acute spinal cord injury. Can J Neurol Sci 14: 211.
Hamilton B B, Rath G J, Meyer PR J r (1976) A basic evaluation framework for spinal cord injury care systems. Paraplegia 14: 87–94.
Semmlow J L, Cone R (1976) Utility of the injury severity score: a confirmation. Health Serv Res Spring: 45–52.
Dietz J M, Bertschy, Gschaedler R, Dollfus P (1986) Reflections on the intensive care of 106 acute cervical spinal cord injury patients in the resuscitation unit of a general traumatology centre. Paraplegia 24: 343–349.
Wilmot C B, Hall K M (1986) Evaluation of the acute management of tetraplegia: conservative versus surgical treatment. Paraplegia 24: 148–153.
Heinemann A W, Yarkony G M, Roth E J, Lovell L, Hamilton B, Grinsburg K et al (1989) Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs general hospital short-term care. Arch Neurol 46: 1098–1102.
Cibeira J B (1970) Some conclusions on a study of 365 patients with spinal cord lesions. Paraplegia 7: 249–254.
Donovan W H, Carter R E, Bedbrook G, Young J S, Griffiths E R (1984) Incidence of medical complications in spinal cord injury: patients in specialized, compared with nonspecialized centres. Paraplegia 22: 282–290.
Frankel H L, Hancock D O, Hyslop G, Melzak J, Michaelis L S, Ungar G H et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7: 179–192.
Yarkony G M, Bass L M, Keenan V, Meyer P R (1985) Contractures complicating spinal cord injury: incidence and comparison between spinal cord centre and general hospital acute care. Paraplegia 23: 265–271.
Barkin M, Herschorn S, Comisarow R H (1982) The urologic care of the spinal cord injured patient. In: Tator CH, editor. Early Management of Acute Spinal Cord Injury. Raven Press, New York: 273–278.
Dollfus P, Mole L (1969) The treatment of the paralysed bladder after spinal injury in the Accident Unit of Colmar. Paraplegia 7: 204–205.
Tator C H, Rowed D W, Schwartz M L, Gerfzbein S D, Bharatival N, Barkin M et al (1984) Management of acute spinal cord injuries. Can J Surg 27: 289–294.
Donovan W M, Dwyer A P (1984) An update on the early management of traumatic paraplegia (nonoperative and operative management). Clin Orthop 189: 12–21.
Johnston M V, Keith R A (1983) Cost-benefits of medical rehabilitation: review and critique. Arch Phys Med Rehabil 64: 147–154.
Young J S (1978) Initial hospitalization and rehabilitation costs for spinal cord injury. Orthop Clin North Am 9: 263–269.
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Tator, C., Duncan, E., Edmonds, V. et al. Complications and costs of management of acute spinal cord injury. Spinal Cord 31, 700–714 (1993). https://doi.org/10.1038/sc.1993.112
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DOI: https://doi.org/10.1038/sc.1993.112