Background

Research has evaluated the effect of surgical timing on patient functional recovery in individuals with spinal cord injury (SCI); however, there is a critical need to assess how demographics, clinical characteristics, and process of care affect functional outcomes.

Objective

We examined the association between demographic, clinical, and process of care factors with post-acute functional status (locomotion and transfer mobility scores) and discharge disposition (home vs. institution) in individuals with SCI.

Methods

This study was a retrospective cohort analysis of the Pennsylvania Trauma Systems Outcomes Study (PTOS) database for individuals with traumatic SCI (N = 2223). We conducted multinomial and binomial logistic regression analyses to examine post-acute functional status and discharge disposition, respectively.

Results

The results indicated that older age, longer length of stay, lower Glasgow Coma Scale (GCS), higher Injury Severity Score (ISS), and individuals with tetraplegia had significantly lower motor functional score at discharge from an acute hospital. In addition, older age, individuals with public-sponsored insurance, longer length of stay, lower GCS, and higher ISS had significantly higher odds of being discharged to an institution, as compared to home. Individuals of Hispanic ethnicity, as compared to White, had lower odds of being discharged to an institution.

Conclusions

The regression models developed in this study were able to better classify discharge destinations compared to the functional outcomes at discharge from the acute hospital. Further research is necessary to determine how these factors and their associations vary nationally across the US, which have the potential to inform trauma and acute care post-SCI.

中文翻译：

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与脊髓损伤患者急性后功能状态和出院处置相关的因素

 背景

研究评估了手术时机对脊髓损伤 (SCI) 患者功能恢复的影响；然而，迫切需要评估人口统计、临床特征和护理过程如何影响功能结果。

 客观的

我们研究了 SCI 患者的人口统计学、临床和护理过程与急性后功能状态（运动和转移活动评分）和出院处置（家庭与机构）之间的关联。

 方法

本研究是对宾夕法尼亚创伤系统结果研究 (PTOS) 数据库中创伤性 SCI 患者 ( N = 2223) 的回顾性队列分析。我们进行了多项和二项逻辑回归分析，分别检查急性后功能状态和出院处置。

 结果

结果表明，年龄较大、住院时间较长、格拉斯哥昏迷量表（GCS）较低、损伤严重程度评分（ISS）较高以及四肢瘫痪的个体在出院时运动功能评分显着较低。此外，与在家相比，年龄较大、拥有公共保险、住院时间较长、GCS 较低和 ISS 较高的个人出院到机构的几率明显更高。与白人相比，西班牙裔人被送往机构的可能性较低。

 结论

与急性医院出院时的功能结果相比，本研究开发的回归模型能够更好地对出院目的地进行分类。需要进一步的研究来确定这些因素及其关联在美国全国范围内的差异，这有可能为 SCI 后的创伤和急性护理提供信息。