Cifu D X, Seel R T, Kreutzer J S, McKinley W O
Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0677, USA.
Arch Phys Med Rehabil. 1999 Jul;80(7):733-40. doi: 10.1016/s0003-9993(99)90219-8.
To examine the effects of age at injury on lengths of stay, treatment costs, and outcomes using a matched sample of tetraplegic spinal cord injury (SCI) patients.
Differences were examined by separating the sample into three age categories (18 to 34, 35 to 64, and 65+ years old) matched for American Spinal Injury Association (ASIA) Motor Impairment Classification and level of neurologic preservation bilaterally. Analysis of variance was used to examine age group differences for lengths of stay, medical expenses, and functional outcome.
Sixteen medical centers in the federally sponsored Spinal Cord Injury Model Systems Project.
Three hundred seventy-five adult patients with tetraplegic SCI admitted between 1988 and 1996 were assessed at acute care admission, inpatient rehabilitation admission, and inpatient rehabilitation discharge.
ASIA Motor Index and Functional Independence Measure (FIM) admission, discharge, and efficiency scores; acute care and rehabilitation lengths of stay and medical care charges; and discharge disposition.
Analyses revealed equivalent lengths of stay and charges for all age groups. There were no age-related differences in ASIA and FIM Motor scores at acute care and inpatient rehabilitation admission. Younger patients' scores on the FIM Motor subscale improved significantly more than did middle and older patients'. The two younger groups of patients had a more significant improvement than did older patients, as indicated by ASIA Motor Index scores. When taking lengths of stay into account, the FIM motor scores of the youngest group of patients improved more quickly than those of the two older groups. Furthermore, the younger and middle age groups demonstrated greater treatment efficiency than the older patient group based on ASIA Motor Index score ratios. Younger patients were least likely to be discharged to institutional settings.
Along with neurologic and functional status, age should be considered when formulating treatment plans and prognostic statements. For older patients, alternative rehabilitation settings with lower-intensity treatment and lower charges may prove to be a more efficacious use of resources.
通过对四肢瘫脊髓损伤（SCI）患者的匹配样本进行研究，探讨受伤年龄对住院时间、治疗费用及预后的影响。
将样本按年龄分为三个类别（18至34岁、35至64岁、65岁及以上），并根据美国脊髓损伤协会（ASIA）运动损伤分类及双侧神经保留水平进行匹配，分析不同年龄组之间的差异。采用方差分析来检验各年龄组在住院时间、医疗费用及功能预后方面的差异。
联邦政府资助的脊髓损伤模型系统项目中的16个医疗中心。
1988年至1996年间收治的375例成年四肢瘫SCI患者，在急性护理入院、住院康复入院及住院康复出院时接受评估。
ASIA运动指数和功能独立性测量（FIM）的入院、出院及效率评分；急性护理和康复住院时间及医疗费用；出院去向。
分析显示所有年龄组的住院时间和费用相当。在急性护理和住院康复入院时，ASIA和FIM运动评分在各年龄组间无年龄相关差异。年轻患者在FIM运动子量表上的评分改善明显大于中年和老年患者。如ASIA运动指数评分所示，两个较年轻组患者的改善比老年患者更显著。考虑住院时间后，最年轻组患者的FIM运动评分比两个较年长组改善更快。此外，基于ASIA运动指数评分比率，年轻和中年组的治疗效率高于老年组。年轻患者出院至机构环境的可能性最小。
制定治疗计划和预后声明时，除了神经和功能状态外，还应考虑年龄因素。对于老年患者，采用强度较低、费用较低的替代康复环境可能是更有效的资源利用方式。
