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Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome.
Spinal Cord ( IF 2.1 ) Pub Date : 2020-01-29 , DOI: 10.1038/s41393-020-0421-y Marco Franceschini 1, 2 , Jacopo Bonavita 3 , Lorenzo Cecconi 4 , Salvatore Ferro 5 , Maria Cristina Pagliacci 6 ,
Spinal Cord ( IF 2.1 ) Pub Date : 2020-01-29 , DOI: 10.1038/s41393-020-0421-y Marco Franceschini 1, 2 , Jacopo Bonavita 3 , Lorenzo Cecconi 4 , Salvatore Ferro 5 , Maria Cristina Pagliacci 6 ,
Affiliation
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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.
中文翻译：
20年后的意大利创伤性脊髓损伤：当前的流行病学趋势和康复结果的早期预测因子。
研究设计对接受康复治疗的急性外伤性脊髓损伤（TSCI）患者进行的多中心前瞻性观察性研究。目的更新意大利TSCI人群的流行病学特征，并验证入院时患者特征对两个结局的影响：功能获得（SCIM III）和出院目的地。在意大利的13个地区建立31个SCI综合康复中心。方法自2013年10月1日至2014年9月30日，纳入所有连续的急性TSCI患者。记录有关康复入院和出院的数据。功能获得和出院目的地被确定为结局指标，并在入院时根据患者特征进行统计分析，以识别早期结局指标。结果510名TSCI患者符合入选标准。跌倒是最常见的病因（45％）。入院时，有35％的病例报告了AIS ABC四肢瘫痪。AIS ABC截瘫占40％；AIS D截瘫/四肢瘫在25％。大多数人出院了（72％）。平均（SD）SCIM增益为38±26点。发现了出院情况的预测模型：入院时摔倒相关伤害，严重SCI（AIS ABC四肢瘫），气管套管或留置导管的人出院的可能性较小（OR 95％CI 0.15 [0.06，0.35] ）。发现SCIM增益预测能力较低的模型，女性预期得分较低，年龄较大，SCI严重程度较高，损伤入院间隔（OAI）发作时间较长，入院时进行机械通气。
更新日期：2020-01-29
中文翻译：
20年后的意大利创伤性脊髓损伤：当前的流行病学趋势和康复结果的早期预测因子。
研究设计对接受康复治疗的急性外伤性脊髓损伤（TSCI）患者进行的多中心前瞻性观察性研究。目的更新意大利TSCI人群的流行病学特征，并验证入院时患者特征对两个结局的影响：功能获得（SCIM III）和出院目的地。在意大利的13个地区建立31个SCI综合康复中心。方法自2013年10月1日至2014年9月30日，纳入所有连续的急性TSCI患者。记录有关康复入院和出院的数据。功能获得和出院目的地被确定为结局指标，并在入院时根据患者特征进行统计分析，以识别早期结局指标。结果510名TSCI患者符合入选标准。跌倒是最常见的病因（45％）。入院时，有35％的病例报告了AIS ABC四肢瘫痪。AIS ABC截瘫占40％；AIS D截瘫/四肢瘫在25％。大多数人出院了（72％）。平均（SD）SCIM增益为38±26点。发现了出院情况的预测模型：入院时摔倒相关伤害，严重SCI（AIS ABC四肢瘫），气管套管或留置导管的人出院的可能性较小（OR 95％CI 0.15 [0.06，0.35] ）。发现SCIM增益预测能力较低的模型，女性预期得分较低，年龄较大，SCI严重程度较高，损伤入院间隔（OAI）发作时间较长，入院时进行机械通气。
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