Original research
International Retrospective Comparison of Inpatient Rehabilitation for Patients With Spinal Cord Dysfunction: Differences According to Etiology

Presented in part to the International Spinal Cord Society, September 2–5, 2012, London, United Kingdom.
https://doi.org/10.1016/j.apmr.2015.10.107Get rights and content

Highlights

  • There are many causes of nontraumatic spinal cord dysfunction.

  • The most common causes were degenerative, malignant tumors, infections, and ischemia.

  • There were major differences between etiologies in epidemiology and outcomes.

  • Besides malignant tumor, all etiologies had significant improvement in the American Spinal Injury Association Impairment Scale grade.

Abstract

Objectives

To describe and compare epidemiologic characteristics and clinical outcomes of patients with nontraumatic spinal cord dysfunction according to etiology.

Design

Retrospective, multicenter open-cohort case series.

Setting

Spinal rehabilitation units (SRUs) in 9 countries.

Participants

Patients (N=956; men, 60.8%; median age, 59.0y [interquartile range, 46–70.0y]; paraplegia, n=691 [72.3%]) with initial onset of spinal cord dysfunction consecutively admitted between January 1, 2008, and December 31, 2010.

Interventions

Not applicable.

Main Outcome Measures

Etiology of spinal cord dysfunction, demographic characteristics, length of stay (LOS) in rehabilitation, pattern of spinal cord dysfunction onset, discharge destination, level of spinal cord damage, and the American Spinal Injury Association Impairment Scale (AIS) grade on admission and discharge.

Results

The most common etiologies were degenerative (30.8%), malignant tumors (16.2%), infections (12.8%), ischemia (10.9%), benign tumors (8.7%), other vascular (8.5%), and other conditions (12.1%). There were major differences in epidemiologic characteristics and clinical outcomes of patients with different etiologies of spinal cord dysfunction. Paraplegia was more common in patients with a malignant tumor and vascular etiologies, while tetraplegia was more common in those with a degenerative etiology, a benign tumor, and infections. Patients with a malignant tumor tended to have the shortest LOS in the SRU, while those with a vascular etiology tended to have the longest. Except for patients with a malignant tumor, all patient groups had a significant change in their AIS grade between admission and discharge.

Conclusions

This international study of spinal cord dysfunction showed substantial variation between the different etiologies regarding demographic and clinical characteristics, including changes in AIS between admission and discharge.

Section snippets

Setting and study design

A retrospective open-cohort case series was conducted of consecutive patients with spinal cord dysfunction admitted for initial inpatient rehabilitation in an SRU between January 1, 2008, and December 31, 2010. This was an international study with 1 SRU in each of 9 countries (Australia, Canada, Italy, India, Ireland, The Netherlands, Switzerland, United Kingdom, United States). Details of the organization of rehabilitation services and perceived barriers to admission and discharge within the

Results

There were 956 eligible patients admitted into the 9 SRUs over the study period. As previously reported, the median age on admission to the SRU was 59 years (IQR, 46–70y; range, 18–97y), and most patients were men (n=581, 60.8%) and had a paraplegic level of injury (n=691, 72.3%).11 The SRU in the United States contributed almost 30% of the cases in the total sample. The median LOS in the SRU was 46.5 days (IQR, 17–89.5d).

There was a diverse range of etiologies.11 These included degenerative

Discussion

There were major differences in the epidemiologic characteristics and clinical outcomes in patients with different etiologies of spinal cord dysfunction. Our study facilitates comparisons regarding the most common etiologies of spinal cord dysfunction between a diverse range of countries and health systems. These comparisons have been difficult to make previously. Clearly, local conditions impact the etiology of spinal cord dysfunction, including referral patterns11, 14; however, our project

Conclusions

This international study of spinal cord dysfunction showed important variation between the different etiologies in demographic and clinical characteristics. Further research, including multiple centers within each country, is required to distinguish country effects from center effects. Our findings also show the potential of using uniform data collection across SRUs in different countries to make detailed comparisons across settings possible. It is believed that adopting the International SCI

Acknowledgments

We thank the following people for assistance with facilitating the data collection: Bianca Fedele, BA(Hons) (Caulfield Hospital and Epworth-Monash Rehabilitation Medicine Unit, Melbourne, Australia); Grace Li, MD (GF Strong Rehabilitation Center, Canada); Michael Baumberger, MD (Swiss Paraplegic Center, Switzerland); Joost van Middendorp, MD, PhD, and Salman Lari, MBBS, MRCS (National Spinal Injuries Center, Stoke Mandeville Hospital, UK); Jolien Vervoordeldonk, MD, and Floris van Asbeck, MD,

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    Disclosures: none.

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