Eastwood E A, Hagglund K J, Ragnarsson K T, Gordon W A, Marino R J
Department of Rehabilitation Medicine, The Mount Sinai School of Medicine, New York, New York, USA.
Arch Phys Med Rehabil. 1999 Nov;80(11):1457-63. doi: 10.1016/s0003-9993(99)90258-7.
To describe changes in acute and rehabilitation length of stay (LOS) for persons with traumatic spinal cord injury (SCI), describe predictors of LOS, and explore year-1 anniversary medical and social outcomes.
Longitudinal, exploratory study of patients with SCI.
Eighteen Model Spinal Cord Injury Centers across the United States.
A total of 3,904 persons discharged from the Model Systems between 1990 and 1997 who had follow-up interviews at 1 year postinjury.
Rehabilitation LOS; injury anniversary year-1 presence of pressure ulcers; incidence of rehospitalization; community or institutional residence; and days per week out of residence.
Acute rehabilitation LOS declined from 74 days to 60 days. Discharges to nursing homes and rehospitalizations increased between 1990 and 1997. Linear regression showed that lower admission motor Functional Independence Measure (FIM) scores, year of discharge from the Model System, method of bladder management, tetraplegia, race, education, marital status, discharge disposition, and age were related to longer LOS. At first anniversary, logistic regressions revealed that lower discharge motor FIM, injury level, and age were related to the presence of pressure ulcers, rehospitalization, residence, and time spent out of residence. Of those discharged to nursing homes, 44% returned to home by year 1, and these individuals had higher functional status and were younger.
High functional status is associated with shorter LOS, discharge to the community, and time spent out of residence, indicating efficiency in the system. For 44.4% of individuals one or more of the following outcomes were observed by first year anniversary: rehospitalization; residing in a skilled nursing facility; having pressure ulcers; or infrequently leaving one's residence.
描述创伤性脊髓损伤（SCI）患者急性住院和康复住院时间（LOS）的变化，描述住院时间的预测因素，并探讨伤后1周年的医疗和社会结局。
对SCI患者进行纵向探索性研究。
美国18个脊髓损伤示范中心。
1990年至1997年间从示范系统出院且在伤后1年接受随访访谈的3904人。
康复住院时间；伤后1周年时压疮的存在情况；再次住院的发生率；社区或机构居住情况；以及每周不在居住地的天数。
急性康复住院时间从74天降至60天。1990年至1997年间，入住疗养院的人数和再次住院的人数有所增加。线性回归显示，入院时较低的运动功能独立性测量（FIM）评分、从示范系统出院的年份、膀胱管理方法、四肢瘫痪、种族、教育程度、婚姻状况、出院处置方式和年龄与较长的住院时间相关。在伤后1周年时，逻辑回归显示，较低的出院运动FIM评分、损伤水平和年龄与压疮的存在、再次住院、居住情况以及不在居住地的时间有关。在入住疗养院的患者中，44%在1年内回到家中，这些人的功能状态较高且年龄较小。
高功能状态与较短的住院时间、出院后回归社区以及不在居住地的时间相关，表明该系统具有效率。到伤后1周年时，44.4%的个体出现了以下一种或多种结局：再次住院；居住在专业护理机构；患有压疮；或很少离开住所。
