Swiss Paraplegic Centre (SPC), Nottwil, Switzerland / Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Department of Clinical Research, University of Basel, Switzerland / Dresden International University, Division of Health Care Sciences, Centre for Clinical Research and Management Education Dresden, Germany.
Swiss Med Wkly. 2020 Jul 30;150:w20291. doi: 10.4414/smw.2020.20291. eCollection 2020 Jul 13.
Examinations and assessments can be used to ensure good quality rehabilitation. Within the framework of a quality improvement project, the aims of the current analysis were: first, to analyse the time points of selected examinations and assessments in the rehabilitation process of patients with a newly acquired spinal cord injury. Second, to identify differences between the subgroups with different aetiologies, levels and completeness of spinal cord injuries. And third, to compare the examinations and assessments performed with the guideline recommendations and to use discrepancies as a starting point for a quality improvement project.
In this retrospective chart analysis, adult patients with a newly acquired spinal cord injury who were admitted to a single specialised acute care and rehabilitation clinic for their first rehabilitation between December 2013 and December 2014 were included and assessed until discharge. The main objective was to assess the time to examinations or assessments after injury or hospital admission in comparison to the respective recommendations. Analyses were done using time-to-event analysis and represented graphically using Kaplan-Meier plots.
Of the 105 patients included in this study (median age 58 years, 29% female), 61% had a traumatic and 39% a non-traumatic spinal cord injury; 39% were paraplegic and 61% were quadriplegic; and 59% had a motor complete and 41% a sensor-motor incomplete spinal cord injury. The percentage of patients for whom the respective assessment or examination was performed and the percentage of these patients for whom it performed within the recommended time were: 90% and 71% for magnetic resonance imaging; 85% and 90% for computed tomography; 87% and 79% for the manual muscle test; 95% and 59% for the International Standards for Neurological Classification of Spinal Cord (ISNCSCI); 84% and 50% for electrophysiological assessment; 73% and 90% for urodynamic testing; and 49% and 53% for lung function testing.
Our data suggest a relevant gap between recommendations and clinical routine for time to some assessments after spinal cord injury. Within the framework of a quality improvement project, the next steps should be to build a national and international consensus on specific time frames for examinations and assessments in patients with a newly acquired spinal cord injury and thereafter, to develop an institutional implementation strategy.  .
检查和评估可用于确保康复质量。在质量改进项目的框架内，本次分析的目的是：首先，分析新发脊髓损伤患者康复过程中选择的检查和评估的时间点。其次，确定不同病因、损伤水平和脊髓损伤完全性亚组之间的差异。第三，比较检查和评估与指南建议的一致性，并将差异作为质量改进项目的起点。
在这项回顾性图表分析中，纳入了 2013 年 12 月至 2014 年 12 月期间在一家专门的急性治疗和康复诊所首次接受康复治疗的新发脊髓损伤成年患者，并进行评估直至出院。主要目的是评估损伤或入院后进行检查或评估的时间与相应建议相比的时间。使用生存时间分析进行分析，并使用 Kaplan-Meier 图进行图形表示。
本研究纳入 105 例患者（中位年龄 58 岁，29%为女性），61%为创伤性，39%为非创伤性脊髓损伤；39%为截瘫，61%为四肢瘫；59%为运动完全性，41%为感觉运动不完全性脊髓损伤。进行相应评估或检查的患者百分比和在推荐时间内进行评估或检查的患者百分比分别为：磁共振成像 90%和 71%；计算机断层扫描 85%和 90%；手动肌肉测试 87%和 79%；国际脊髓损伤神经分类标准（ISNCSCI） 95%和 59%；电生理评估 84%和 50%；尿动力学检查 73%和 90%；肺功能检查 49%和 53%。
我们的数据表明，一些脊髓损伤后评估的时间建议与临床常规之间存在显著差距。在质量改进项目的框架内，下一步应该是就新发脊髓损伤患者的检查和评估的具体时间框架达成国家和国际共识，然后制定机构实施策略。
