Cervical spinal cord injury--a public catastrophe.

Cervical spine cord injuries continue to be a major cause of death and disability for trauma victims. Motor vehicle trauma results in 500 to 650 quadriplegic patients per year. Most of the patients are cared for at Level I trauma centers which may not have a dedicated rehabilitation facility. Long-term rehabilitation, nursing care, and financial support remain difficult areas in the overall management of these injuries. Seventy-one cervical spine fracture patients were admitted to this medical center over a 2-year period. Twenty-two patients had a neurologic injury, 15 quadriplegic patients, and seven with incomplete deficits. Vehicular trauma was the etiology in 14 injuries; gunshot wounds in five; falls in three. Twelve of these 22 patients had associated injuries, including chest and abdominal trauma. Prolonged stays in the intensive care unit were common (avg. = 13.5 days). Bronchoscopy (8/22 patients) and aggressive pulmonary care were constantly needed. Six patients died in the intensive care unit. The average hospital stay of the survivors was 45 days. Three of the 16 surviving patients were ventilator dependent at the time of discharge. Ten patients were discharged to a rehabilitation center, one to a nursing home, and five went home (one on a ventilator). The total hospital charges were $1,250,000. No financial resources were available for five of the 16 surviving patients. Four patients had resources which covered less than 50% of the total charges. Average hospital charges for survivors were $50,370. Maximum reimbursement using all outlier days under DRG 5 would be $12,385. The financial support of initial hospitalization, rehabilitation, and nursing care for these quadriplegic patients is a serious national health care issue.