Hospital care of postacute spinal cord lesion patients in Italy: analysis of readmissions into the GISEM study.

OBJECTIVES: To define the clinical characteristics of hospital readmissions of subjects with spinal cord lesion. DESIGN: Prospective, multicenter, 2-yr survey in 32 spinal cord lesion centers in Italy. Readmitted traumatic or nontraumatic spinal cord lesion patients were included. Main outcome measures were number of readmissions, their causes, complications on admission, and length of stay. RESULTS: Out of 2070 total admissions of patients with spinal cord lesion, 1056 (51.0%) were readmissions. The median period between the onset of disease and readmission was 3.4 yrs. A program of functional gain was the main cause of readmission (33%). A pressure sore was reported in 20.6% of cases on readmission. Readmission for a program of functional gain was correlated to nontraumatic and incomplete lesions. Readmission necessary for clinical complications was correlated to traumatic spinal cord lesion and completeness of the lesion. A longer length of stay correlated with cause of readmission, admission to rehabilitation centers, and nontraumatic origin. CONCLUSIONS: Readmissions account for more than half of total admissions to centers for spinal cord lesion in Italy. The main burden is represented by a program of functional gain, pressure sores, and urological complications.

An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study.

OBJECTIVE: To describe the etiology, clinical presentation, complications, outcome indicators, and links between emergency and acute intervention and rehabilitation of patients with traumatic spinal cord injury (SCI). DESIGN: Multicenter prospective study involving patients with SCI discharged, after rehabilitative care, between February 1, 1997, and January 31, 1999. SETTING: Thirty-two Italian hospitals involved in SCI rehabilitation. PARTICIPANTS: Six hundred eighty-four patients with traumatic SCI on their first admission to a rehabilitation center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Neurologic improvement (NI), bladder autonomy, feelings of dependency, and destination were evaluated on discharge. Pressure ulcers on admission, time from injury to admission, and length of stay (LOS) were considered as indirect measures of the effectiveness of the health system. RESULTS: Traumatic etiology had a male-to-female ratio of 4:1 (548:136). Collision on the road was the main cause of traumatic injury (53.8%). Mean time from injury to admission was 36.8 days; 126 patients (18%) were admitted within the first week after injury. Mean LOS was 135.5 days. In 184 patients (26.9%), a pressure ulcer was present on admission. On discharge, NI was recorded in 179 patients (26.2%), whereas 446 (65%) and 418 (61%) had bladder and bowel autonomy, respectively, and 560 (81.9%) returned home. In the multivariate analysis, independent variables predicting poor outcome (NI, feelings of dependency, sphincter autonomy, discharge to home, LOS) were related both to the lesion (completeness, cervical involvement) and to the indicators of health service organization (time from injury to admission, complications on admission and during stay). CONCLUSIONS: Our focus on the etiology of traumatic SCI showed that efforts should be made to prevent collisions on the road. Our study also highlights problems in the comprehensive management of patients with SCI in Italy. Better organization could help reduce the time from injury to admission, the number of complications on admission, and LOS, and it could help improve rehabilitation outcome.