Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Arch Phys Med Rehabil. 2011 Oct;92(10):1534-41. doi: 10.1016/j.apmr.2011.04.018.
To determine the incidence of venous thromboembolism (VTE) among patients with traumatic spinal cord injury (TSCI) in acute care settings that is attributable to extended length of stay (LOS), insurance status, and access to rehabilitation.
Population-based, retrospective cohort study.
Levels I through III and undesignated trauma centers.
Patients with acute TSCI (N=3389) discharged from all acute care hospitals in South Carolina from 1998 through 2009, and a representative sample of patients with TSCI (n=186) interviewed 1 year later.
Not applicable.
VTE while in acute care.
Annual incidence of TSCI is 67.2 per million in the state of South Carolina, while the cumulative incidence of VTE is 4.1%. Patients with TSCI who developed VTE were nearly 4 times more likely (odds ratio [OR], 3.98; 95% confidence interval [CI], 2.57-6.17) to have been those who stayed 12 days or longer in acute care after adjusting for covariates. The adjusted mean LOS in acute care was 32.0 days (95% CI, 27.7-37.2) for patients with TSCI who had indigent insurance versus 11.3 days (95% CI, 4.9-17.6) for Medicare, and 18.5 days (95% CI, 14.5-22.5) for commercial insurance after adjusting for VTE, disposition, and year of discharge. Only 20% of the persons under indigent care received rehabilitation from accredited rehabilitation facilities in contrast to 60% under commercial insurance.
Fewer patients with TSCI under indigent care received postacute rehabilitation compared with Medicare or commercial insurance. Insurance status remains a major barrier to timely transfer to rehabilitation, leading to protracted LOS in acute care with increased risk of VTE.
确定在急性护理环境中，创伤性脊髓损伤（TSCI）患者中归因于延长住院时间（LOS）、保险状况和获得康复机会的静脉血栓栓塞（VTE）发生率。
基于人群的回顾性队列研究。
一级至三级和未指定创伤中心。
1998 年至 2009 年期间，南卡罗来纳州所有急性护理医院出院的急性 TSCI 患者（N=3389），以及 1 年后接受 TSCI 患者代表性样本（n=186）访谈。
不适用。
急性护理期间的 VTE。
南卡罗来纳州的 TSCI 年发病率为每百万人 67.2 例，而 VTE 的累积发病率为 4.1%。调整协变量后，发生 VTE 的 TSCI 患者在急性护理中住院 12 天或更长时间的可能性几乎高出 4 倍（优势比[OR]，3.98；95%置信区间[CI]，2.57-6.17）。调整 VTE、处置和出院年份后，拥有贫困保险的 TSCI 患者在急性护理中的调整平均 LOS 为 32.0 天（95%CI，27.7-37.2），而 Medicare 为 11.3 天（95%CI，4.9-17.6），商业保险为 18.5 天（95%CI，14.5-22.5）。只有 20%的贫困护理人员在急性护理中接受了经认可的康复设施的康复治疗，而商业保险的比例为 60%。
与 Medicare 或商业保险相比，贫困护理下的 TSCI 患者接受急性后康复治疗的比例较少。保险状况仍然是及时转至康复的主要障碍，导致急性护理中的 LOS 延长，VTE 的风险增加。
