Cardenas Diana D, Hoffman Jeanne M, Kirshblum Steven, McKinley William
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
Arch Phys Med Rehabil. 2004 Nov;85(11):1757-63. doi: 10.1016/j.apmr.2004.03.016.
To examine the frequency and reasons for rehospitalization in persons with acute traumatic spinal cord injury (SCI) during follow-up years and to examine the association between rehospitalization and demographics, neurologic category, payer sources, length of stay (LOS), discharge motor FIM instrument score, and discharge residence.
Survey design with analysis of cross-sectional data.
Model Spinal Cord Injury Systems (MSCIS) centers.
Data for 8668 persons with SCI from 16 MSCIS centers entered in the National Spinal Cord Injury Statistical Center database between 1995 and 2002.
Not applicable.
MSCIS Forms I and II were used to identify the annual incidence, medical complications, and etiologies of rehospitalizations reported at 1-, 5-, 10-, 15-, and 20-year follow-ups.
The leading cause of rehospitalization was diseases of the genitourinary system, including urinary tract infections (UTIs). Diseases of the respiratory system tended to be more likely in patients with tetraplegia (C1-8 American Spinal Injury Association [ASIA] grades A, B, C); whereas patients with paraplegia (T1-S5 ASIA grades A, B, C) were more likely to be rehospitalized for pressure ulcers. The rate of rehospitalization was significantly higher at year 1, 5, and 20 for those who were discharged to a skilled nursing facility after acute rehabilitation. Lower motor score using the FIM was predictive of rehospitalization (P=.000). The average LOS per rehospitalization at the year-5 follow-up was approximately 12 days, which is lower than in past MSCIS reports.
Despite improvements in SCI medical management, rehospitalization rates remain high, with an increased incidence in conditions associated with the genitourinary system (including UTIs), respiratory complications (including pneumonia), and diseases of the skin (including pressure ulcers). Acutely injured patients need close follow-up to reduce morbidity and rehospitalizations.
研究急性创伤性脊髓损伤（SCI）患者随访期间再入院的频率及原因，并探讨再入院与人口统计学特征、神经学分类、支付来源、住院时间（LOS）、出院时FIM运动功能评分及出院居住地之间的关联。
横断面数据分析的调查设计。
脊髓损伤示范系统（MSCIS）中心。
1995年至2002年间录入国家脊髓损伤统计中心数据库的16个MSCIS中心的8668例SCI患者的数据。
不适用。
使用MSCIS表格I和II来确定1年、5年、10年、15年和20年随访时报告的再入院年发病率、医疗并发症及病因。
再入院的主要原因是泌尿生殖系统疾病，包括尿路感染（UTIs）。呼吸系统疾病在四肢瘫患者（C1-8美国脊髓损伤协会[ASIA]分级A、B、C）中更常见；而截瘫患者（T1-S5 ASIA分级A、B、C）因压疮再入院的可能性更大。急性康复后出院至专业护理机构的患者在第1年、第5年和第20年的再入院率显著更高。使用FIM的较低运动评分可预测再入院情况（P = 0.000）。在5年随访时，每次再入院的平均住院时间约为12天，低于以往MSCIS报告中的数据。
尽管SCI医疗管理有所改善，但再入院率仍然很高，与泌尿生殖系统（包括UTIs）、呼吸并发症（包括肺炎）和皮肤疾病（包括压疮）相关的疾病发病率增加。急性损伤患者需要密切随访以降低发病率和再入院率。
