TY - JOUR
T1 - Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome
AU - Franceschini, Marco
AU - Bonavita, Jacopo
AU - Cecconi, Lorenzo
AU - Ferro, Salvatore
AU - Pagliacci, Maria Cristina
AU - for the Italian SCI Study Group
AU - Ferro, Salvatore
AU - Bellentani, Mariadonata
AU - Franceschini, Marco
AU - Cavina, Augusto
AU - Bonavita, Jacopo
AU - Pagliacci, Maria Cristina
AU - Biggeri, Annibale
AU - Cecconi, Lorenzo
AU - De Iure, Federico
AU - Gordini, Giovanni
AU - Redaelli, Tiziana
AU - Actis, Maria Vittoria
AU - Del Popolo, Giulio
AU - Bertagnoni, Giannettore
AU - Avesani, Renato
AU - Falabella, Vincenzo
N1 - Funding Information:
This research was approved and funded by the Italian Ministry of Health (CCM number 15756 of 17-07-2012 and “Institutional research”). A regional network for a systematic data collection was created under the supervision of Age.Na.S. (National Agency for Regional Health Services).
Publisher Copyright:
© 2020, The Author(s), under exclusive licence to International Spinal Cord Society.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Study design: Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation. Objectives: To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination. Setting: Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions. Methods: All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors. Results: Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission. Conclusions: Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.
AB - Study design: Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation. Objectives: To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination. Setting: Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions. Methods: All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors. Results: Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission. Conclusions: Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.
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U2 - 10.1038/s41393-020-0421-y
DO - 10.1038/s41393-020-0421-y
M3 - Article
C2 - 31996778
AN - SCOPUS:85087849807
VL - 58
SP - 768
EP - 777
JO - Spinal Cord
JF - Spinal Cord
SN - 1362-4393
IS - 7
ER -