Richard-Denis Andréane, Ehrmann Feldman Debbie, Thompson Cynthia, Bourassa-Moreau Étienne, Mac-Thiong Jean-Marc
From the Hôpital du Sacré-Coeur (AR-D, CT, J-MM-T); Faculty of Medicine, University of Montreal (AR-D, DEF, ÉB-M, J-MM-T); Hôpital Sainte-Justine (J-MM-T), Montréal; and Centre for Interdisciplinary Research in Rehabilitation, Québec (DEF), Québec, Canada.
Am J Phys Med Rehabil. 2017 Jul;96(7):449-456. doi: 10.1097/PHM.0000000000000659.
Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center.
A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center.
Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P < 10), and average costs were also higher (median, Canadian $17,920.0 vs. $10,521.6; P = 0.004) for group 2, despite similar characteristics. Late transfer to the SCI center was the main predictive factor of longer LOS and increased costs.
Early admission to the SCI center was associated with shorter LOS and lower costs for patients sustaining tetraplegia. Early referral to an SCI center before surgery could lower the financial burden for the health care system.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the optimal timing for transfer of individuals with cervical traumatic spinal cord injury (SCI) in order to decrease acute care resource utilization; (2) Determine benefits of a complete perioperative management in a specialized SCI center; and (3) Identify factors that may influence resource utilization for acute care following motor-complete tetraplegia.
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
急性脊髓损伤（SCI）中心旨在优化脊髓损伤后的治疗效果。然而，目前尚无将患者从地区医院转运至脊髓损伤中心的时间框架以提高急性护理的成本效益。我们的目的是比较早期和晚期转运至脊髓损伤中心后的成本和住院时间（LOS）。
进行了一项涉及116例患者的回顾性队列研究。第1组（n = 87）在创伤后立即在脊髓损伤中心接受治疗，而第2组（n = 29）仅在手术后才转运至脊髓损伤中心。采用直接比较和多元线性回归分析来评估成本、住院时间与转运至脊髓损伤中心时间之间的关系。
与第1组（中位数40.0天）相比，第2组的住院时间明显更长（中位数93.0天；P < 0.001），且第2组的平均成本也更高（中位数，17920.0加元对10521.6加元；P = 0.004），尽管两组患者特征相似。晚期转运至脊髓损伤中心是住院时间延长和成本增加的主要预测因素。
对于四肢瘫痪患者，早期入住脊髓损伤中心与较短的住院时间和较低的成本相关。术前尽早转诊至脊髓损伤中心可减轻医疗保健系统的经济负担。
高级。认证：学术物理医学与康复医师协会经继续医学教育认证委员会认可，可为医生提供继续医学教育。学术物理医学与康复医师协会将该活动指定为最多1.5个美国医学协会（AMA）PRA第1类学分™。医生应仅根据其参与活动的程度申请相应学分。
