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Jacob A, Wirtz CR, Loibl M, Kruger S, Blankson BH, Dunn RN, Kruger NA. Predictors of Early Mortality After Traumatic Spinal Cord Injury in South Africa. Global Spine J 2025; 15:2359-2366. [PMID: 39523107 PMCID: PMC11561959 DOI: 10.1177/21925682241300269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
Study DesignRetrospective cohort study.ObjectivesTo identify predictors for early mortality following traumatic spinal cord injury (TSCI), as recognition of factors associated with early mortality is essential for public resource allocation and optimized acute care.MethodsRetrospective Analysis of SCI patients admitted to the acute SCI ward from 2003 to 2022 was performed. Days elapsing from the date of injury to date of death established the survival time. Early mortality was defined as survival time ≤ 365 days. Multivariable logistic regression was used in modeling of early death following TSCI with age, gender, neurologic deficit, type of neurologic injury, ventilation status, and count of complications as covariates.ResultsSimple logistic regression indicated a significant association of early mortality with the number of complications (P < .0001), neurological deficit (P < .0001), complete neurological injury (P < .0001), ventilation status (P < .0001), and age group (P < .0003). After adjusting for other covariates, complete neurological injury (OR: 1.75, P < .0001), ventilation (OR: 2.80, P < .0001), and Age group (over 60 OR: 17.71, P < .0001) were significantly associated with early mortality. The multivariable model showed a good overall fit (Hosmer-Lemeshow P = .315; AUC 0.85).ConclusionsPredictors of early mortality after TSCI are high complete spinal cord injury, age, number of complications, and the need for ventilation. Identification of high-risk patients is crucial to rationalize and improve acute care to potentially reduce mortality rates.
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Affiliation(s)
- Alina Jacob
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Neurosurgery, University of Ulm, Ulm, Germany
| | | | - Markus Loibl
- Department of Orthopaedic Surgery, Neurosurgery and Spine Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Stefan Kruger
- Department of Neurosurgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Benjamin H. Blankson
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Robert N. Dunn
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nicholas A. Kruger
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
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Craven BC, Dengler J, Rybkina J, Gulasingam S, Bishop K, Eftekhar P, Kalsi-Ryan S, Furlan JC, Silverman J, Guy K, Robinson L. A quality improvement initiative to develop an interprofessional peripheral nerve transfer clinic for individuals with traumatic cervical spinal cord injury. Disabil Rehabil 2025:1-11. [PMID: 40110653 DOI: 10.1080/09638288.2025.2461267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 01/26/2025] [Accepted: 01/28/2025] [Indexed: 03/22/2025]
Abstract
PURPOSE Loss of upper extremity (UE) function impacts almost every aspect of daily life and upper limb recovery is reported to be a major priority of individuals living with tetraplegia. Surgical peripheral nerve transfer (PNT) offers the potential to restore volitional control of elbow, wrist and hand function of individuals with C5-C8 tetraplegia AIS A-C. Unfortunately, while there is growing evidence supporting the role of PNT in spinal cord injury (SCI) rehabilitation, there are currently no internationally-recognized consensus-derived best practices for provision of PNT following spinal cord injury (SCI) and few programs have focused on interdisciplinary collaboration during patient selection, surgical decision making, management of medical comorbidities and postoperative rehabilitation. This quality improvement initiative aimed to establish a novel, interdisciplinary PNT program with the goal of optimizing UE recovery and function in individuals with tetraplegia in Canada. MATERIALS AND METHODS An interprofessional team assembled to complete a detailed exploration of care segments, organizing and sequencing care delivery. RESULTS AND CONCLUSIONS As a result of this initiative, a care map of planned interprofessional services, their optimal timing across the continuum of care, and clinical functional and community integration outcomes were developed. Data collection and program evaluation are ongoing, and further work to mitigate barriers and develop educational materials around PNT surgery are intended to improve medical decision making and best practice implementation.
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Affiliation(s)
- B Catharine Craven
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Julia Rybkina
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Sivakumar Gulasingam
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kelly Bishop
- Ambulatory Rehab Hand Therapy Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Parvin Eftekhar
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Julio C Furlan
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jordan Silverman
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kristina Guy
- Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Larry Robinson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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3
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Wang C, Shang S, Hou M, Wang J, Kang Y, Lou Y, Wang W, Zhao H, Chen L, Zhou H, Feng S. Epidemiological age-based differences in traumatic spinal cord injury patients: A multicenter study based on 13,334 inpatients. J Spinal Cord Med 2025; 48:232-240. [PMID: 38426946 PMCID: PMC11864031 DOI: 10.1080/10790268.2024.2309716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
CONTEXT Compared with younger traumatic spinal cord injury (TSCI) patients, the elderly had longer delays in admission to surgery, higher proportion of incomplete injury, and longer hospital stays. However, in China, the country with the largest number of TSCI patients, there have been no large-scale reports on their age differences. OBJECTIVES To explore the age-based differences among TSCI inpatients, focusing on the demographic and clinical characteristics, treatment status, and economic burden. METHODS We collected the medical records of 13,334 inpatients with TSCI in the 30 hospitals of China, from January 1, 2013 to December 31, 2018. Trends are expressed as annual percentage changes (APCs) and 95% confidence intervals (CIs). RESULTS A total of 13,334 inpatients were included. Both the number and proportion of the elderly showed an increasing trend. The APC of the number and proportion in patients ≥85 years were 39.5% (95% CI, 14.3 to 70.3; P < 0.01) and 30.5% (95% CI, 8.6 to 56.9; P < 0.01), respectively. Younger patients were more likely to undergo decompression surgery, and older patients were more likely to receive high-dose methylprednisolone sodium succinate/methylprednisolone (MPSS/MP). Of the patients ≥85 years, none underwent decompression surgery within 8 h, and only 1.4% received a high dose of MPSS/MP within 8 h after injury. Elderly patients had lower hospitalization costs than younger. The total and daily medical costs during hospitalization of patients ≥85 years were 8.06 ± 18.80 (IQR: 5.79) and 0.61 ± 0.73 (IQR: 0.55) thousands dollars, respectively. CONCLUSIONS As the first study to focus on age differences of TSCI patients in China, this study found many differences, in demographic and clinical characteristics, treatment status, and economic costs, between older and younger TSCI patients. The number and proportion of elderly patients increased, and the rate of early surgery for elderly patients is low.
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Affiliation(s)
- Chaoyu Wang
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
| | - Shenghui Shang
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- The Second Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Mengfan Hou
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
| | - Jinghua Wang
- Laboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, People’s Republic of China
| | - Yi Kang
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
| | - Yongfu Lou
- The Second Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
| | - Wei Wang
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Hua Zhao
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Lingxiao Chen
- Faculty of Medicine and Health, University of Sydney, Institute of Bone and Joint Research, The Kolling Institute, Sydney, Australia
| | - Hengxing Zhou
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China
- Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, People’s Republic of China
- The Second Hospital of Shandong University, Jinan, Shandong, People’s Republic of China
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Diop M, Epstein D. A Systematic Review of the Impact of Spinal Cord Injury on Costs and Health-Related Quality of Life. PHARMACOECONOMICS - OPEN 2024; 8:793-808. [PMID: 39150624 PMCID: PMC11499558 DOI: 10.1007/s41669-024-00517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To systematically review the health-related quality of life (HRQoL) burden and costs of spinal cord injury (SCI) on health services, patients and wider society. METHODS A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was conducted in March 2021 through Scopus, PubMed and Embase databases. Inclusion criteria were quantitative studies on SCI reporting healthcare costs, social costs and/or HRQoL measured with the Euroqol EQ-5D or Short-Form 36. Risk of bias was assessed using the QualSyst tool. Descriptive analyses, random-effects direct meta-analysis and random-effects meta-regression were conducted. RESULTS A total of 67 studies were eligible for inclusion. SCI individuals tend to report higher HRQoL in mental than physical dimensions of the Short-Form 36. Neurological level of SCI negatively affects HRQoL. Cross-sectional studies find employment is associated with better HRQoL, but the effect is not observed in longitudinal studies. The estimated lifetime expenditure per individual with SCI ranged from US$0.7 million to US$2.5 million, with greater costs associated with earlier age at injury, neurological level, United States of America healthcare setting and the inclusion of non-healthcare items in the study. CONCLUSIONS SCI is associated with low HRQoL on mobility and physical dimensions. Mental health scores tend to be greater than physical scores, and most dimensions of HRQoL appear to improve over time, at least over the first year. SCI is associated with high costs which vary by country. CLINICAL TRIALS REGISTRATION This review was registered in PROSPERO (registration number: CRD42021235801).
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Affiliation(s)
- Modou Diop
- Hospinnomics (Paris School of Economics & Assistance Publique - Hôpitaux de Paris), Hôtel Dieu 1 Parvis Notre-Dame, 75004, Paris, France.
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
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Craven BC, Bateman EA, Flett H, Farahani F, Wolfe DL, Askari S, Omidvar M, Alavinia M. The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement. Healthcare (Basel) 2024; 12:1084. [PMID: 38891159 PMCID: PMC11171508 DOI: 10.3390/healthcare12111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. METHODS This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. RESULTS Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. CONCLUSIONS PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.
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Affiliation(s)
- Beverley Catharine Craven
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emma A. Bateman
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Heather Flett
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Farnoosh Farahani
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Dalton L. Wolfe
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Faculty of Health Sciences, School of Health Studies, Western University, London, ON N6A 5C1, Canada
| | - Sussan Askari
- Faculty of Physical Medicine and Rehabilitation, Providence Care Hospital, Queen’s University, Kingston, ON K7L 4X3, Canada;
| | - Maryam Omidvar
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Mohammad Alavinia
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
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6
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Whitten TA, Loyola Sanchez A, Gyawali B, Papathanassoglou EDE, Bakal JA, Krysa JA. Predicting inpatient rehabilitation length of stay for adults with traumatic spinal cord injury. J Spinal Cord Med 2024:1-11. [PMID: 38466871 DOI: 10.1080/10790268.2024.2325165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Most post-injury traumatic spinal cord injury (TSCI) care occurs in the inpatient rehabilitation setting. The inpatient rehabilitation length of stay (R-LOS) has been shown to be a significant predictor of motor function restoration in persons with TSCI. Due to the complexity, and heterogeneity of individuals with TSCI, the R-LOS is challenging to predict at admission. PURPOSE To identify the main predictors of R-LOS and derive an equation to estimate R-LOS in persons with TSCI. METHODS This is a retrospective analysis of data from adults with TSCI from The Rick Hansen Spinal Cord Injury Registry in Alberta, Canada, who received rehabilitation care between May 10, 2005, and January 28, 2020. Multiple linear regression analysis was used to determine significant relationships between R-LOS and measures of participant demographics, length of stay, impairment and injury classification, and comorbidities. RESULTS The analysis included 736 adults with TSCI from an eligible cohort of 1365. The median R-LOS was 65 days (IQR 39-99 days), ranging from 1 to 469 days. Multivariate linear regression analysis identified two significant predictors of R-LOS, total FIM score and the injury classification. This model was used to derive a R-LOS prediction equation, which explained 34% of the variance in R-LOS. CONCLUSION We developed a simple equation to predict R-LOS based on the level of impairment and total FIM scores in persons with TSCI. These data have implications for health system planning, improvement, and innovation, and provide insights to support further research into the predictors of R-LOS, identification of higher-risk individuals.
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Affiliation(s)
- Tara A Whitten
- Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU) Data Platform, Alberta Health Services, Calgary, Canada
| | - Adalberto Loyola Sanchez
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
| | - Bina Gyawali
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
| | - Elisavet D E Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Jeffrey A Bakal
- Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU) Data Platform, Alberta Health Services, Calgary, Canada
| | - Jacqueline A Krysa
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, Canada
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Smith CW, Malhotra AK, Hammill C, Beaton D, Harrington EM, He Y, Shakil H, McFarlan A, Jones B, Lin HM, Mathieu F, Nathens AB, Ackery AD, Mok G, Mamdani M, Mathur S, Wilson JR, Moreland R, Colak E, Witiw CD. Vision Transformer-based Decision Support for Neurosurgical Intervention in Acute Traumatic Brain Injury: Automated Surgical Intervention Support Tool. Radiol Artif Intell 2024; 6:e230088. [PMID: 38197796 PMCID: PMC10982820 DOI: 10.1148/ryai.230088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Purpose To develop an automated triage tool to predict neurosurgical intervention for patients with traumatic brain injury (TBI). Materials and Methods A provincial trauma registry was reviewed to retrospectively identify patients with TBI from 2005 to 2022 treated at a specialized Canadian trauma center. Model training, validation, and testing were performed using head CT scans with binary reference standard patient-level labels corresponding to whether the patient received neurosurgical intervention. Performance and accuracy of the model, the Automated Surgical Intervention Support Tool for TBI (ASIST-TBI), were also assessed using a held-out consecutive test set of all patients with TBI presenting to the center between March 2021 and September 2022. Results Head CT scans from 2806 patients with TBI (mean age, 57 years ± 22 [SD]; 1955 [70%] men) were acquired between 2005 and 2021 and used for training, validation, and testing. Consecutive scans from an additional 612 patients (mean age, 61 years ± 22; 443 [72%] men) were used to assess the performance of ASIST-TBI. There was accurate prediction of neurosurgical intervention with an area under the receiver operating characteristic curve (AUC) of 0.92 (95% CI: 0.88, 0.94), accuracy of 87% (491 of 562), sensitivity of 87% (196 of 225), and specificity of 88% (295 of 337) on the test dataset. Performance on the held-out test dataset remained robust with an AUC of 0.89 (95% CI: 0.85, 0.91), accuracy of 84% (517 of 612), sensitivity of 85% (199 of 235), and specificity of 84% (318 of 377). Conclusion A novel deep learning model was developed that could accurately predict the requirement for neurosurgical intervention using acute TBI CT scans. Keywords: CT, Brain/Brain Stem, Surgery, Trauma, Prognosis, Classification, Application Domain, Traumatic Brain Injury, Triage, Machine Learning, Decision Support Supplemental material is available for this article. © RSNA, 2024 See also commentary by Haller in this issue.
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Affiliation(s)
| | | | - Christopher Hammill
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Derek Beaton
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Erin M. Harrington
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Yingshi He
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Husain Shakil
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Amanda McFarlan
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Blair Jones
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Hui Ming Lin
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - François Mathieu
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Avery B. Nathens
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Alun D. Ackery
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Garrick Mok
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Muhammad Mamdani
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Shobhit Mathur
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Jefferson R. Wilson
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
| | - Robert Moreland
- From the Division of Neurosurgery (C.W.S., A.K.M., E.M.H., Y.H.,
H.S., J.R.W., C.D.W.), Trauma Program and Quality Assurance (A.M., E.C.),
Department of Emergency Medicine (A.D.A., G.M.), and Department of Medical
Imaging (S.M., R.M., E.C.), St Michael's Hospital, 30 Bond St, Toronto,
ON, Canada M5B 1W8; Li Ka Shing Knowledge Institute (C.W.S., A.K.M., E.M.H.,
Y.H., H.S., H.M.L., M.M., S.M., J.R.W., E.C., C.D.W.) and Data Science and
Advanced Analytics (C.H., D.B., B.J., M.M.), Unity Health Toronto, Toronto,
Ontario, Canada; Institute for Health Policy, Management and Evaluation (A.K.M.,
H.S., M.M., J.R.W., C.D.W.), Interdepartmental Division of Critical Care (F.M.),
Temerty Faculty of Medicine (A.D.A., G.M., M.M., S.M., J.R.W., R.M., C.D.W.),
and Leslie Dan Faculty of Pharmacy (M.M.), University of Toronto, Toronto,
Ontario, Canada; and Division of Trauma Surgery, Sunnybrook Health Sciences
Centre, Toronto, Ontario, Canada (A.B.N.)
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8
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Galehdar N, Heydari H. Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study. BMC Nurs 2024; 23:142. [PMID: 38419004 PMCID: PMC10903105 DOI: 10.1186/s12912-024-01797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients. METHODS This study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. RESULTS Two themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support). CONCLUSION Resolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Nasrin Galehdar
- Social Determinates of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Heshmatolah Heydari
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
- French Institute of Research and High Education (IFRES-INT), Paris, France.
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9
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Dousty M, Fleet DJ, Zariffa J. Hand Grasp Classification in Egocentric Video After Cervical Spinal Cord Injury. IEEE J Biomed Health Inform 2024; 28:645-654. [PMID: 37093722 DOI: 10.1109/jbhi.2023.3269692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The hand function of individuals with spinal cord injury (SCI) plays a crucial role in their independence and quality of life. Wearable cameras provide an opportunity to analyze hand function in non-clinical environments. Summarizing the video data and documenting dominant hand grasps and their usage frequency would allow clinicians to quickly and precisely analyze hand function. METHOD We introduce a new hierarchical model to summarize the grasping strategies of individuals with SCI at home. The first level classifies hand-object interaction using hand-object contact estimation. We developed a new deep model in the second level by incorporating hand postures and hand-object contact points using contextual information. RESULTS In the first hierarchical level, a mean of 86% ±1.0% was achieved among 17 participants. At the grasp classification level, the mean average accuracy was 66.2 ±12.9%. The grasp classifier's performance was highly dependent on the participants, with accuracy varying from 41% to 78%. The highest grasp classification accuracy was obtained for the model with smoothed grasp classification, using a ResNet50 backbone architecture for the contextual head and a temporal pose head. DISCUSSION We introduce a novel algorithm that, for the first time, enables clinicians to analyze the quantity and type of hand movements in individuals with spinal cord injury at home. The algorithm can find applications in other research fields, including robotics, and most neurological diseases that affect hand function, notably, stroke and Parkinson's.
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Wallis CJD, Jerath A, Aminoltejari K, Kaneshwaran K, Salles A, Buntin MB, Coburn NG, Wright FC, Gotlib Conn L, Heybati K, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong KA, Bass BL, Detsky AS, Satkunasivam R. Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures. JAMA Surg 2024; 159:151-159. [PMID: 38019486 PMCID: PMC10687714 DOI: 10.1001/jamasurg.2023.6031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023]
Abstract
Importance Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex. Objective To examine the association between surgeon sex and health care costs among patients undergoing surgery. Design, Setting, and Participants This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023. Exposure Surgeon sex. Main Outcome and Measure The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates. Results Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202). Conclusions and Relevance This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.
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Affiliation(s)
- Christopher J. D. Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Khatereh Aminoltejari
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Natalie G. Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frances C. Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Colin McCartney
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kathleen A. Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara L. Bass
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Allan S. Detsky
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas
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11
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Wagner A, Brach M, Scheel-Sailer A, Friedli M, Hund-Georgiadis M, Jordan X, Schubert M, Gemperli A. Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study. BMC Health Serv Res 2023; 23:1393. [PMID: 38087349 PMCID: PMC10714621 DOI: 10.1186/s12913-023-10429-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Persons with spinal cord injury (SCI) living in the community often require care. The boundaries between professional home care and informal care are blurred, and it is unclear who the typical user of home care is. The objective of this study was to describe the characteristics of persons with SCI using professional home care in Switzerland, determine the frequency of home care visits, and investigate the association of sociodemographic factors, SCI-specific characteristics, secondary health conditions, and functional independence with the use of home care. METHODS We used cross-sectional data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study (SwiSCI). Out of 3,959 eligible individuals 1294 completed the questionnaire and were included in the analysis (response rate 33%). Using descriptive statistics, differences between home care users and non-users as well as the frequency of home care visits were investigated. The association between sociodemographic factors, SCI-specific characteristics, secondary health conditions, functional independence and the use of home care was analyzed using multivariable logistic regression. Multiple imputation was used to account for missing data. RESULTS Of 1,294 participants, 280 (22%) used professional home care. The median weekly professional home care duration was 6 h (Q1 = 2, Q3 = 12). More home care was used in persons with lower functional independence (Odds ratio (OR) 0.30 per 10 unit decrease in the Spinal Cord Independence Measure, 95%-Confidence interval (CI) 0.24-0.37), fewer secondary health conditions (OR 0.96 per unit Spinal Cord Injury Secondary Conditions Scale, 95%-CI 0.94-0.99), tetraplegia (OR 2.77, 95%-CI 1.92-4.00), women (OR 2.42, 95%-CI 1.70-3.43), higher age (OR 1.22 per 10 years increase, 95%-CI 1.06-1.39), living alone (OR 2.48, 95%-CI 1.53-4.03), and those receiving support from an informal caregiver (OR 1.88, 95%-CI 1.27-2.77). CONCLUSIONS This is the first study to examine the use of professional home care from the perspective of persons with SCI in Switzerland. Lower functional independence strongly predicts increased home care use. The findings showed that professional home care complements informal care and is more likely to be used by individuals with SCI who live alone, have tetraplegia, and are female.
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Affiliation(s)
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | | | | | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland.
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12
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Wiest MJ, Gargaro J, Bayley MT. What Is the Pathway to the Best Model of Care for Traumatic Spinal Cord Injury? Evidence-Based Guidance. Top Spinal Cord Inj Rehabil 2023; 29:103-111. [PMID: 38174142 PMCID: PMC10759857 DOI: 10.46292/sci23-00059s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Introduction People with traumatic spinal cord injury (tSCI) experience lifelong physical and emotional health impacts, needing specialized care that is complex to navigate. The non-standardized care pathways used by different jurisdictions to address these needs lead to care inequities and poor health outcomes. Purpose To develop an evidence-based integrated tSCI Care Pathway, from time of injury to life in the community. Methods and Analysis Eighty key partners engaged in planning, providing, and receiving tSCI care (1) identified existing guidelines, pathways, and care models; (2) created the tSCI Care Pathway with key elements or building blocks ("the what"), not specific recommendations ("the how") for each care stage (Acute, Rehabilitation, and Community), with elements highlighting the role of primary care and equity considerations on the pathway; (3) identified regional gaps in the tSCI Pathway and prioritized them for implementation; and (4) developed quality indicators. Outcomes The tSCI Pathway was drafted in overarching and detailed formats. For Acute Care, building blocks focused on appropriate assessment, initial management, and transition planning; for Rehabilitation, building blocks focused on access to specialized rehabilitation and assessment and planning of community needs; for Community, building blocks focused on follow-up, mechanisms for re-access, and holistic support for persons and families; and for equity considerations, building blocks focused on those at-risk or requiring complex supports. Team-based primary care and navigation supports were seen as crucial to reduce inequities. Conclusion This is the first comprehensive care pathway for tSCI. The Pathway is grounded in person-centred care, integrated care and services, and up-to-date clinical practice guidelines. The tSCI Care Pathway is flexible to regional realities and individual needs to ensure equitable care for all.
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Affiliation(s)
- Matheus Joner Wiest
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Judith Gargaro
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Mark T. Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
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Kadambi A, Bandini A, Ramkalawan RD, Hitzig SL, Zariffa J. Designing an Egocentric Video-Based Dashboard to Report Hand Performance Measures for Outpatient Rehabilitation of Cervical Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:75-87. [PMID: 38174134 PMCID: PMC10759816 DOI: 10.46292/sci23-00015s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Functional use of the upper extremities (UEs) is a top recovery priority for individuals with cervical spinal cord injury (cSCI), but the inability to monitor recovery at home and limitations in hand function outcome measures impede optimal recovery. Objectives We developed a framework using wearable cameras to monitor hand use at home and aimed to identify the best way to report information to clinicians. Methods A dashboard was iteratively developed with clinician (n = 7) input through focus groups and interviews, creating low-fidelity prototypes based on recurring feedback until no new information emerged. Affinity diagramming was used to identify themes and subthemes from interview data. User stories were developed and mapped to specific features to create a high-fidelity prototype. Results Useful elements identified for a dashboard reporting hand performance included summaries to interpret graphs, a breakdown of hand posture and activity to provide context, video snippets to qualitatively view hand use at home, patient notes to understand patient satisfaction or struggles, and time series graphing of metrics to measure trends over time. Conclusion Involving end-users in the design process and breaking down user requirements into user stories helped identify necessary interface elements for reporting hand performance metrics to clinicians. Clinicians recognized the dashboard's potential to monitor rehabilitation progress, provide feedback on hand use, and track progress over time. Concerns were raised about the implementation into clinical practice, therefore further inquiry is needed to determine the tool's feasibility and usefulness in clinical practice for individuals with UE impairments.
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Affiliation(s)
- Adesh Kadambi
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Andrea Bandini
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- The Biorobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Ryan D. Ramkalawan
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - José Zariffa
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
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Neu S, Matta R, Locke J, Almeida RMD, Stoelzel M, Covernton PJO, Herschorn S. Treatment Patterns in Men Prescribed Benign Prostatic Obstruction or Overactive Bladder Medications in Canada: A Retrospective Population-based Study. Urology 2023; 180:219-226. [PMID: 37454770 DOI: 10.1016/j.urology.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To characterize first therapeutic change and healthcare resource utilization in older men initiating an overactive bladder (OAB) or benign prostatic obstruction (BPO) medication. METHODS A retrospective cohort study using health administrative data from ICES in Ontario, Canada (from April 01, 2010 to December 31, 2018) was conducted in men aged ≥66 years with ≥1 OAB (β3 agonist, antimuscarinic) or BPO (α-blocker, 5-α-reductase inhibitor) prescription and ≥1-year postindex data (index=first observed dispensation). EXCLUSIONS prescriptions for these drugs ≤1 year preindex, a related procedure ≤5 years. Patients were grouped by condition based on index prescription. Treatment changes in relation to OAB and BPO were characterized by type. Costs and healthcare resource utilization pre- and post-index were compared. RESULTS Age, geographic region, and income were similar between groups. The most common initial treatments were antimuscarinics (78.1%) in the OAB group and alpha-blockers (86.4%) in the BPO group. The OAB group was more likely to experience a therapeutic change and had a shorter time to first change in therapy (78 [30,231] vs 104 [30,350] days) and higher mean healthcare costs both pre- ($12,354 vs $11,497) and postindex ($14,423 vs $12,852). The most common first therapeutic change in both groups was discontinuing treatment (OAB: 75.6%; BPO: 69.9%). CONCLUSION Men initiating OAB medications changed therapy sooner than those initiating BPO medications. Most discontinued first-line therapy without initiating further treatment, suggesting unmet need in this population.
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Affiliation(s)
- Sarah Neu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rano Matta
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Locke
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Sender Herschorn
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Raza S, Thiruchelvam D, Redelmeier DA. Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada. JAMA Netw Open 2023; 6:e2335831. [PMID: 37768661 PMCID: PMC10539992 DOI: 10.1001/jamanetworkopen.2023.35831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care. Objective To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design. Design, Setting, and Participants This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada. Exposure Police shootings compared with other mechanisms of injury involving police. Main Outcomes and Measures Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability. Results Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis. Conclusions and Relevance In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
| | - Donald A. Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES) in Ontario, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Bae SW, Shin HI, Bang MS, Lee MY. Epidemiology of Work-Related Traumatic Spinal Cord Injury: An Analysis of Workers' Compensation Claims in Korea, 2011-2019. J Occup Environ Med 2023; 65:e453-e457. [PMID: 37026737 PMCID: PMC10332647 DOI: 10.1097/jom.0000000000002852] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVE We aimed to identify the incidence and burden of work-related traumatic spinal cord injury (wrTSCI) in Korea in the 10-year period from 2010 to 2019. METHODS We used nationwide workers' compensation insurance data. The study population comprised industrially injured workers with TSCI diagnosis codes. The annual incidence of wrTSCI (number per million workers) was calculated. RESULTS The mean annual incidence of wrTSCI was 22.8/1,000,000 (95% confidence interval, 20.5 to 25.0), and the mean total cost per claim was 231.40 million KRW. The incidence of TSCI in the cervical region was the highest (13.1/1,000,000; 95% confidence interval, 11.4 to 14.9), and most cases were in the construction industry (47.3%). CONCLUSION These findings can help identify specific at-risk groups and facilitate the development of prevention strategies.
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Yamada Y, Yokogawa N, Kato S, Sasagawa T, Tsuchiya H, Nakashima H, Segi N, Ito S, Funayama T, Eto F, Yamaji A, Yamane J, Nori S, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Kuroda A, Inoue G, Kakutani K, Kakiuchi Y, Kiyasu K, Tominaga H, Tokumoto H, Iizuka Y, Takasawa E, Akeda K, Takegami N, Funao H, Oshima Y, Kaito T, Sakai D, Yoshii T, Ohba T, Otsuki B, Seki S, Miyazaki M, Ishihara M, Okada S, Imagama S, Watanabe K. Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan. J Clin Med 2023; 12:jcm12051867. [PMID: 36902654 PMCID: PMC10003092 DOI: 10.3390/jcm12051867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan-Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.
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Affiliation(s)
- Yohei Yamada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Correspondence: ; Tel.: +81-76-265-2374
| | - Takeshi Sasagawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki 306-0433, Japan
| | - Junichi Yamane
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo 208-0011, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
- Department of Orthopedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
- Department of Orthopedics, Saiseikai Shiga Hospital, Shiga 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Kenji Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo 101-8393, Japan
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akiyoshi Kuroda
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Kenichiro Kakutani
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan
| | - Hiroyuki Tominaga
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yoichi Iizuka
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Koji Akeda
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Haruki Funao
- Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-0124, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan
- Department of Orthopedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa 259-1193, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 113-8519, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Masashi Miyazaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan
| | - Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Seiji Okada
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
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Conti A, Campagna S, Gianino MM, Mamo C, Onorati R, Albanesi B, Dimonte V, Borraccino A. Incidence and mortality of spinal cord injury from 2008 to 2020: a retrospective population-based cohort study in the Piedmont Region, Italy. Spinal Cord 2023; 61:99-105. [PMID: 35933474 PMCID: PMC9362101 DOI: 10.1038/s41393-022-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Retrospective population-based cohort study. OBJECTIVES To determine the incidence and mortality of spinal cord injuries (SCI) in the Piedmont Region of Northwestern Italy. SETTING Publicly-funded SCI rehabilitation centres in the Piedmont Region. METHODS Administrative databases were used to identify individuals at their first admission to a SCI rehabilitation centre from January 1st, 2008 to December 31st, 2020. Cases were stratified by age and aetiology (traumatic SCI, TSCI; non-traumatic SCI, NTSCI). Age- and aetiology-specific incidence rate and person-year mortality rates were calculated for each year. Case lethality was reported as deaths among prevalent cases for each year. RESULTS A total of 892 cases were identified (56.4% TSCI). The average annual crude incidence rate was 17.9 per million population, decreasing from 26.0 in 2008 to 10.8 in 2020. Young adults and the elderly represented the majority of TSCI and NTSCI cases, respectively. Of the 235 individuals who died during the study period, 58.3% had NTSCI. The mortality rate per 1000 person-years decreased from 16.3 in 2009 to 8.5 in 2020, while case lethality more than tripled (from 17.2 in 2009 to 57.1 in 2020). CONCLUSIONS We identified a decreasing trend in SCI incidence and mortality rates, with an increased case lethality over the study period, especially in NTSCI. Given these changes in the epidemiology of SCI, community services offered after rehabilitation should be strengthened to enhance their effectiveness and contribute to increased survival in this population.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Carlo Mamo
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Roberta Onorati
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Beatrice Albanesi
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy.
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Pinto D, Heinemann AW, Chang SH, Charlifue S, Field-Fote EC, Furbish CL, Jayaraman A, Tefertiller C, Taylor HB, French DD. Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury. J Neuroeng Rehabil 2023; 20:10. [PMID: 36681852 PMCID: PMC9867867 DOI: 10.1186/s12984-023-01134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. METHODS A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. RESULTS Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. CONCLUSIONS The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
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Affiliation(s)
- Daniel Pinto
- Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
- World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Shuo-Hsiu Chang
- Neurorecovery Research Center, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Edelle C Field-Fote
- Spinal Cord Injury, Shepherd Center, Atlanta, Georgia
- Division of Physical Therapy, Emory University, Atlanta, USA
| | | | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | | | - Heather B Taylor
- Spinal Cord Injury and Disability Research, TIRR Memorial Hermann, Houston, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Health Services Research and Development Service, US Department of Veterans Affairs, Chicago, USA
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20
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Bandini A, Dousty M, Hitzig SL, Craven BC, Kalsi-Ryan S, Zariffa J. Measuring Hand Use in the Home after Cervical Spinal Cord Injury Using Egocentric Video. J Neurotrauma 2022; 39:1697-1707. [PMID: 35747948 DOI: 10.1089/neu.2022.0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Egocentric video has recently emerged as a potential solution for monitoring hand function in individuals living with tetraplegia in the community, especially for its ability to detect functional use in the home environment. The aim of this study was to develop and validate a wearable vision-based system for measuring hand use in the home among individuals living with tetraplegia. Several deep learning algorithms for detecting functional hand-object interactions were developed and compared. The most accurate algorithm was used to extract measures of hand function from 65 h of unscripted video recorded at home by 20 participants with tetraplegia. These measures were: the percentage of interaction time over total recording time (Perc); the average duration of individual interactions (Dur); and the number of interactions per hour (Num). To demonstrate the clinical validity of the technology, egocentric measures were correlated with validated clinical assessments of hand function and independence (Graded Redefined Assessment of Strength, Sensibility and Prehension [GRASSP], Upper Extremity Motor Score [UEMS], and Spinal Cord Independent Measure [SCIM]). Hand-object interactions were automatically detected with a median F1-score of 0.80 (0.67-0.87). Our results demonstrated that higher UEMS and better prehension were related to greater time spent interacting, whereas higher SCIM and better hand sensation resulted in a higher number of interactions performed during the egocentric video recordings. For the first time, measures of hand function automatically estimated in an unconstrained environment in individuals with tetraplegia have been validated against internationally accepted measures of hand function. Future work will necessitate a formal evaluation of the reliability and responsiveness of the egocentric-based performance measures for hand use.
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute and Toronto, Ontario, Canada.,The BioRobotics Institute and Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mehdy Dousty
- KITE Research Institute and Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, and University of Toronto, Toronto, Ontario, Canada
| | - B Catharine Craven
- KITE Research Institute and Toronto, Ontario, Canada.,Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Division of Physical Medicine and Rehabilitation Temerty Faculty of Medicine, and University of Toronto, Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute and Toronto, Ontario, Canada.,Department of Physical Therapy and University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute and Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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21
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Malekzadeh H, Golpayegani M, Ghodsi Z, Sadeghi-Naini M, Asgardoon M, Baigi V, Vaccaro AR, Rahimi-Movaghar V. Direct Cost of Illness for Spinal Cord Injury: A Systematic Review. Global Spine J 2022; 12:1267-1281. [PMID: 34289308 PMCID: PMC9210246 DOI: 10.1177/21925682211031190] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Providing a comprehensive review of spinal cord injury cost of illness studies to assist health-service planning. METHODS We conducted a systematic review of the literature published from Jan. 1990 to Nov. 2020 via Pubmed, EMBASE, and NHS Economic Evaluation Database. Our primary outcomes were overall direct health care costs of SCI during acute care, inpatient rehabilitation, within the first year post-injury, and in the ensuing years. RESULTS Through a 2-phase screening process by independent reviewers, 30 articles out of 6177 identified citations were included. Cost of care varied widely with the mean cost of acute care ranging from $290 to $612,590; inpatient rehabilitation from $19,360 to $443,040; the first year after injury from $32,240 to $1,156,400; and the ensuing years from $4,490 to $251,450. Variations in reported costs were primarily due to neurological level of injury, study location, methodological heterogeneities, cost definitions, study populations, and timeframes. A cervical level of the injury, ASIA grade A and B, concomitant injuries, and in-hospital complications were associated with the greatest incremental effect in cost burden. CONCLUSION The economic burden of SCI is generally high and cost figures are broadly higher for developed countries. As studies were only available in few countries, the generalizability of the cost estimates to a regional or global level is only limited to countries with similar economic status and health systems. Further investigations with standardized methodologies are required to fill the knowledge gaps in the healthcare economics of SCI.
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Affiliation(s)
- Hamid Malekzadeh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Golpayegani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orthopedics and Neurosurgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
- Spine Program, University of Toronto, Toronto, Canada
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22
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Maggio MG, Naro A, De Luca R, Latella D, Balletta T, Caccamo L, Pioggia G, Bruschetta D, Calabrò RS. Body Representation in Patients with Severe Spinal Cord Injury: A Pilot Study on the Promising Role of Powered Exoskeleton for Gait Training. J Pers Med 2022; 12:jpm12040619. [PMID: 35455735 PMCID: PMC9030625 DOI: 10.3390/jpm12040619] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with spinal cord injury (SCI) complain of changes in body representation, potentially leading to negative physical and psychological consequences. The purpose of our study is to evaluate the effects of robotic training with the Ekso-GT on body representation (BR) and on the quality of life in patients with SCI. The trial was designed as a pilot, assessor-blinded study. Forty-two inpatients with a diagnosis of SCI, classified as either American Spinal Cord Injury Association Impairment Scale (AIS), were enrolled in this study and randomized into either a control (CG: n = 21) or an experimental (EG: n = 21) group. Patients in the EG received rehabilitation training with the Ekso-GT device, whereas the CG patients were trained with conventional physical therapy (CPT), which consisted of physical and occupational therapy and psychological support. We considered as a primary outcome the modified Body Uneasiness Test (MBUT), focusing on three specific subscales on the patient’s perception of BR, i.e., the Global Severity Index (MBUT-GSI), which is an indicator of body suffering; the Positive Symptom Distress Index (MBUT-PSDI) that expresses an individual’s psychological distress; and the Lower Limb MBUT (MBUT-LL), which indicates the subject’s perception of their thighs/legs. The Short-Form-12 Health Status Questionnaire (SF12) and the Beck’s Depression Inventory (BDI) were used as secondary outcomes to evaluate the effect of the training on the quality of life and the psychological status. Non-parametric statistical analysis showed that the effect of the two treatments was significantly different on MBUT (BR), SF-12 (quality of life), and, partially, BDI (mood). Particularly, patients belonging to the EG achieved a major improvement in nearly all test scores compared to those in the CG. Our data suggest that the Ekso-GT training could be helpful in achieving positive changes in BR in patients with chronic SCI, especially in reducing psychological distress (PSDI) and thigh/leg perception (MBUT-LL) with an overall improvement in quality of life (SF-12).
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy;
| | - Antonino Naro
- AOU Policlinico “G. Martino”, 98125 Messina, Italy; (A.N.); (D.B.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Desiree Latella
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Lory Caccamo
- Neuropsychology Unit, University of Padua, 35121 Padua, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy;
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
- Correspondence: ; Tel.: +39-090-6012-3850
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23
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Shepherd J, Tu K, Young J, Chishtie J, Craven BC, Moineddin R, Jaglal S. Identifying cases of spinal cord injury or disease in a primary care electronic medical record database. J Spinal Cord Med 2021; 44:S28-S39. [PMID: 34779726 PMCID: PMC8604482 DOI: 10.1080/10790268.2021.1971357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR). DESIGN A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database. SETTING Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada. PARTICIPANTS A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score. RESULTS 126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9-78.4), 98.5% specificity (97.3-99.3), 89.9% PPV (82.2-95.0), 94.7% NPV (92.8-96.3), and an F-score of 79.1. CONCLUSIONS Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.
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Affiliation(s)
- John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: John Shepherd, Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, Ontario, Canada.
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,North York General Hospital, Toronto, Ontario, Canada,Toronto Western Hospital Family Health Team, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jawad Chishtie
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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24
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Siméon H, Rouget B, Bladou F, Bernhard JC, Alezra E, Delleci C, Petit L, Vital JM, Robert G, Capon G. [Urinary drainage of spinal cord injured patients in the acute phase of trauma: A descriptive, retrospective study]. Prog Urol 2021; 32:6-13. [PMID: 34863636 DOI: 10.1016/j.purol.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Urinary retention in the acute phase of a spinal cord injury (SCI) requires bladder drainage (BD). International scientific societies recommend early implementation of intermittent catheterisation (IC) to prevent lower urological complications, preserve fertility, the urological future of the patient and improve its quality of life. The aim of our study was to analyze the mode of BD in the acute phase of a trauma in patients with SCI. MATERIALS AND METHODS We retrospectively analyzed the mode of BD of patients with SCI in the acute phase of trauma at the Bordeaux University Hospital from 2013 to 2018. RESULTS The care pathways of 81 patients were analyzed; patients were hospitalized in intensive care unit (ICU) (42%, n=34), in orthopaedic ward (19.8%, n=16) or in ICU and orthopaedic ward (38.2%, n=31). All of them had an indwelling catheter (IUD) inserted before IC was introduced in 56 of them (69%). On hospital discharge, IC was the BD for only 37% of patients, with differences according to the care pathway: 65% of patients leaving ICU were on IC, compared with 11% leaving orthopaedic ward. 80% of patients who had IC in ICU had an IUD installed in orthopaedic ward. CONCLUSION In this study, during the acute phase of a trauma in the majority of SCI patient, IC was introduced only in a minority of patients and the promotion was different within the hospital care pathways. Those results enhanced the need for IC awareness in different hospital units to standardize the best patient care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- H Siméon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France.
| | - B Rouget
- Service de chirurgie urologique, hôpital Robert-Boulin Libourne, Libourne, France
| | - F Bladou
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - J-C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - E Alezra
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - C Delleci
- Service de médecine physique et réadaptation, CHU de Bordeaux, Bordeaux, France
| | - L Petit
- Service de réanimation chirurgicale, CHU de Bordeaux, Bordeaux, France
| | - J-M Vital
- Service de chirurgie orthopédique et de traumatologie, CHU de Bordeaux, Bordeaux, France
| | - G Robert
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - G Capon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
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25
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van Diemen T, Verberne DPJ, Koomen PSJ, Bongers-Janssen HMH, van Nes IJW. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases 2021; 7:86. [PMID: 34580276 DOI: 10.1038/s41394-021-00451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Explorative retrospective cohort study. OBJECTIVE Secondary health conditions (SHCs) are common in people with spinal cord injury (SCI). To date, little is known about the effectiveness of long-term follow-up care in preventing SHCs. The objective of this study was to explore the therapeutic content of an interdisciplinary follow-up clinic by retrospective analyses of provided recommendations and collected data concerning SHCs. SETTING Rehabilitation center Sint Maartenskliniek, The Netherlands. METHODS All people with SCI, who visited one or more outpatient interdisciplinary follow-up clinics between January 2012 and October 2020 were included in this study. Treatment information was retrieved from their medical records. RESULTS The 264 participants of the follow-up clinic received, after their first visit, an average of 3.9 recommendations regarding SHCs. Most recommendations were preventive in nature (43%), and were related to physical SHCs (61%). Most recommendations were followed by the participants (34% out of 40% that could be determined) and half of the underlying problems were solved (31% out of 62%). The bodyweight and respiratory function remained stable over time. CONCLUSION Participants of the interdisciplinary follow-up clinics received extensive recommendations on a variety of subjects, which most likely, reflects the interdisciplinary approach. Recommendations were followed-up to a large extent, resulting in solving half of the underlying SHCs. This way, worse SHCs were prevented by the recommendations. This findings, together with the stability of respiratory function and bodyweight, suggests the added value of the interdisciplinary follow-up clinic to usual care. More prospective research is necessary to investigate the (cost-)effectiveness.
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Affiliation(s)
- Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Daan P J Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Patrick S J Koomen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ilse J W van Nes
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
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Mollayeva T, Sutton M, Escobar M, Hurst M, Colantonio A. The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury. PM R 2021; 13:683-694. [PMID: 32710463 DOI: 10.1002/pmrj.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Evidence of the effect of comorbid spinal cord injury (SCI) on cognitive outcomes in persons undergoing rehabilitation following newly diagnosed traumatic brain injury (TBI) is limited. We conducted a population-based study to investigate this effect. OBJECTIVE To compare cognitive outcomes in patients with TBI with and without a comorbid SCI. SETTING/PARTICIPANTS Adult patients diagnosed with TBI were identified and followed for 1 year through provincial health administrative data; those who entered inpatient rehabilitation were studied. DESIGN A retrospective matched cohort study using the National Rehabilitation Reporting System data of all acute care and freestanding rehabilitation hospitals in Ontario, Canada. MAIN MEASURES The exposure was a comorbid SCI in patients with diagnosed TBI. Exposed patients were matched to unexposed (TBI-only) on sex, age, injury severity, and income, in a ratio of one to two. Gain differences in the cognitive subscale of the Functional Independence Measure were compared between exposed and unexposed patients using multivariable mixed linear model, controlling for comorbidity propensity score, gains in motor function, and rehabilitation care indicators. RESULTS Over the first year post injury, 12 750 (0.84%) of all TBI patients entered inpatient rehabilitation, of whom 1359 (10.66%) had a comorbid SCI. A total of 1195 exposed patients (65.4% male, mean age 50.9 ± 20.6 for male and 61.8 ± 21.8 for female patients) were matched to 2390 unexposed patients. Controlling for confounding, exposed patients had lower cognitive gain (beta -0.43; 95% CI -0.72, -0.15), for both male (beta -0.39; 95% CI -0.75, -0.03) and female (beta -0.51; 95% CI -0.97, -0.05) patients. The adverse effects of comorbid SCI were driven largely by lower gains in problem solving and comprehension. CONCLUSIONS Adult patients with TBI and comorbid SCI showed a lower cognitive domain response to inpatient rehabilitation than patients with TBI alone. Identifying patients at risk for worse cognitive outcomes may facilitate the development of targeted strategies that improve cognitive outcomes.
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Affiliation(s)
| | - Mitchel Sutton
- KITE- Toronto Rehab-University Health Network, Toronto, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mackenzie Hurst
- KITE- Toronto Rehab-University Health Network, Toronto, Canada
| | - Angela Colantonio
- KITE- Toronto Rehab-University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
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Abstract
OBJECTIVE Cervical spinal cord injury (cSCI) can impair motor function in the upper limbs. Video from wearable cameras (egocentric video) has the potential to provide monitoring of rehabilitation outcomes at home, but methods for automated analysis of this data are needed. Wrist flexion and extension are essential elements to track grasping strategies after cSCI, as they may reflect the use of the tenodesis grasp, a common compensatory strategy. However, there is no established method to evaluate wrist flexion and extension from egocentric video. METHODS We propose a machine-learning-based approach comprising three steps-hand detection, pose estimation, and arm orientation estimation-to estimate wrist angle data, leading to the detection of tenodesis grasp. RESULTS The hand detection in conjunction with the pose estimation algorithm correctly located wrist and index finger metacarpophalangeal coordinates in 63% and 76% of 15,319 annotated frames, respectively, extracted from egocentric videos of individuals with cSCI performing activities of daily living in a home simulation laboratory. The arm orientation algorithm had a mean absolute error of 2.76 +/- 0.39 degrees in 12,863 labeled frames. Using these estimates, the presence of a tenodesis grasp was correctly detected in 72% +/- 11% of frames in videos of 6 activities. CONCLUSION The results provided a clear indication of which participants relied on tenodesis grasp and which did not. SIGNIFICANCE This paradigm provides the first method that can enable clinicians and researchers to monitor the use of the tenodesis grasp by individuals with cSCI at home, with implications for remote therapeutic guidance.
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Bandini A, Kalsi-Ryan S, Craven BC, Zariffa J, Hitzig SL. Perspectives and recommendations of individuals with tetraplegia regarding wearable cameras for monitoring hand function at home: Insights from a community-based study. J Spinal Cord Med 2021; 44:S173-S184. [PMID: 33960874 PMCID: PMC8604485 DOI: 10.1080/10790268.2021.1920787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Wearable cameras have great potential for producing novel outcome measures of upper limb (UL) function and guiding care in individuals with cervical spinal cord injury (cSCI) living in the community. However, little is known about the perspectives of individuals with cSCI on the potential adoption of this technology. OBJECTIVE To analyze feedback from individuals with cSCI regarding the use of wearable cameras to record daily activities at home, in order to define guidelines for improving the design of this technology and fostering its implementation to optimize UL rehabilitation. DESIGN Mixed-methods study. PARTICIPANTS Thirteen adults with cSCI C3-C8 AIS A-D impairment. MEASURES Interview including survey and semi-structured questions. RESULTS Participants felt that this technology can provide naturalistic information regarding hand use to clinicians and researchers, which in turn can lead to better assessments of UL function and optimized therapies. Participants described the technology as easy-to-use but often reported discomfort that prevented them from conducting long recordings of fully natural activities. Privacy concerns included the possibility to capture household members and personal information displayed on objects (e.g. smartphones). CONCLUSION We provide the first set of guidelines to help researchers and therapists understand which steps need to be taken to translate wearable cameras into outpatient care and community-based research for UL rehabilitation. These guidelines include miniaturized and easy-to-wear cameras, as well as multiple measures for preventing privacy concerns such as avoiding public spaces and providing control over the recordings (e.g. start and stop the recordings at any time, keep or delete a recording).
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Sharwood LN, Whyatt D, Vaikuntam BP, Cheng CL, Noonan VK, Joseph AP, Ball J, Stanford RE, Kok MR, Withers SR, Middleton JW. A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study. BMC Health Serv Res 2021; 21:292. [PMID: 33794879 PMCID: PMC8015029 DOI: 10.1186/s12913-021-06235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Timely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 h from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement. METHODS This record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged ≥16 years with incident TSCI in NSW (2013-2016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications. RESULTS Inclusion criteria identified 316 patients, geospatial analysis showed that over half (53%, n = 168) of all patients were injured within 60 min road travel of a SCIU, yet only 28.6% (n = 48) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma (p < 0.01) but higher ICISS (p < 0.001), cervical injury (p < 0.01), and transferred by air-ambulance (p < 0.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries (p < 0.01) or incomplete injury (p < 0.01). Patients not admitted to SCIU at all were older (p = 0.05) with lower levels of injury (p < 0.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p < 0.001). Complications included pressure injury, deep vein thrombosis, urinary infection, among others. CONCLUSIONS Getting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. The higher rates of complication following delayed transfer to a SCIU should motivate health service policy makers to investigate reasons for this practice and consent to improvement strategies. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 min radius, enabling the benefits of specialised care.
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Affiliation(s)
- Lisa N Sharwood
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia.
- University of New South Wales, Faculty of Medicine and Health, NSW Black Dog Institute, Sydney, Australia.
- University of Technology Sydney, Faculty of Engineering, Sydney, NSW, Australia.
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia.
| | - David Whyatt
- University of Western Australia, (M706), 35 Stirling Highway, Perth, 6009, Australia
| | - Bharat P Vaikuntam
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Christiana L Cheng
- Praxis Spinal Cord Institute, 6400-818 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, 6400-818 W 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Anthony P Joseph
- Royal North Shore Hospital, Trauma Department, Reserve Road, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathon Ball
- Royal North Shore Hospital, Neurosurgery, St Leonards, NSW, 2065, Australia
| | - Ralph E Stanford
- Prince of Wales Hospital, Spinal Cord Injury Unit, Randwick, NSW, 2033, Australia
| | - Mei-Ruu Kok
- University of Western Australia, (M706), 35 Stirling Highway, Perth, 6009, Australia
| | - Samuel R Withers
- Australian Institute of Robotic Orthopaedics, Perth, Western Australia, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Reserve Road, St Leonards, NSW, 2065, Australia
- Agency for Clinical Innovation, NSW Health, Reserve Road, St Leonards, NSW, 2065, Australia
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The Changing Etiology and Epidemiology of Traumatic Spinal Injury: A Population-Based Study. World Neurosurg 2021; 149:e116-e127. [PMID: 33631390 DOI: 10.1016/j.wneu.2021.02.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE No previous large population-based studies of traumatic spinal injury (TSI) rates, trends, and patterns exist. We aimed to fill this knowledge gap on TSI epidemiology using a population-based study of 13 million people. METHODS This is a descriptive cross-sectional cohort study that analyzes a national, mandatory reporting database for all emergency departments and ambulatory care centers in Ontario over 15 years. Demographics of TSI, trends in the TSI rate, etiology, transfer, disposition, comorbidities, and associated traumatic brain injury or spinal cord injury were analyzed. RESULTS There were 167,357 TSI-related emergency department visits resulting in 70,684 hospitalizations and 376 deaths. The overall rate of TSI significantly increased from 66.94 to 118.61 per 100,000. Female patients had greater rates of TSI. Older patients had greater rates of TSI, especially related to falls. Fall was found to be the commonest mechanism of TSI, whereas motor vehicle collisions scaled down to the third commonest mechanism of TSI. Sport-related TSI had the greatest percentage of increase in the rate over all mechanisms (221%, P < 0.001). TSI with associated traumatic brain injury comprised 6% of the cohort but had the greatest percentage increase (91%) in the rate compared to all other TSI forms. CONCLUSIONS The rate of TSI continues to rise in Ontario as the population ages. The rise is primarily attributed to a shift in the epidemiology and etiology of TSI from a younger male population toward an older female population, with falls as the primary injury mechanism. Establishing preventive measures to address this shift is essential.
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Kerwin AJ, Diaz Zuniga Y, Yorkgitis BK, Mull J, Hsu AT, Madbak FG, Ebler DJ, Skarupa DJ, Shiber J, Crandall ML. Diaphragm pacing decreases hospital charges for patients with acute cervical spinal cord injury. Trauma Surg Acute Care Open 2020; 5:e000528. [PMID: 33381653 PMCID: PMC7754627 DOI: 10.1136/tsaco-2020-000528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cervical spinal cord injury (CSCI) is devastating and costly. Previous research has demonstrated that diaphragm pacing (DPS) is safe and improves respiratory mechanics. This may decrease hospital stays, vent days, and costs. We hypothesized DPS implantation would facilitate liberation from ventilation and would impact hospital charges. Methods We performed a retrospective review of patients with acute CSCI between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity matching based on age, injury severity score, ventilator days, hospital length of stay, and need for tracheostomy. We then adjusted total hospital charges by year using US Bureau of Labor Statistics annual adjusted Medical Care Prices. Bivariate and multivariate linear regression statistics were performed using STATA V.15. Results Between July 2011 and May 2017, all patients with acute CSCI were evaluated for DPS implantation. 40 patients who had laparoscopic DPS implantation (DPS) were matched to 61 who did not (NO DPS). Following DPS implantation, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs −13 mL; 95% CI 46 to 131 vs −78 to 51 mL, respectively; p=0.004). Median time to liberation after DPS was significantly shorter (10 vs 29 days; 95% CI 6.5 to 13.6 vs 23.1 to 35.3 days; p<0.001). Adjusted hospital charges were significantly lower for DPS on multivariate linear regression models controlling for year of injury, sex, race, injury severity, and age (p=0.003). Discussion DPS implantation in patients with acute CSCI produces significant improvements in spontaneous Vt and reduces time to liberation, which translated into reduced hospital charges on a risk-adjusted, inflation-adjusted model. DPS implantation for patients with acute CSCI should be considered. Level of evidence Level III.
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Affiliation(s)
- Andrew J Kerwin
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Yohan Diaz Zuniga
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Brian K Yorkgitis
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Jennifer Mull
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Albert T Hsu
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Firas G Madbak
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - David J Ebler
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - David J Skarupa
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Joseph Shiber
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Marie L Crandall
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
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Dionne A, Richard-Denis A, Lim V, Mac-Thiong JM. Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury. Spinal Cord 2020; 59:642-648. [PMID: 32892207 DOI: 10.1038/s41393-020-00542-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective review of data from a prospective database of a Level 1 trauma center. OBJECTIVES This project aims to identify factors collected during the acute and rehabilitative care following a traumatic spinal cord injury (TSCI) associated with success and failure to return home after inpatient intensive functional rehabilitation (IFR). SETTING Level 1 trauma center specialized in TSCI care in Montreal, Canada. METHODS All eligible patients from our prospective database were separated into two groups according to discharge destination following IFR. Clinical variables collected during the acute and rehabilitative care as well as demographic variables were compared between patients who managed to return home (Group 1) and those who were discharged elsewhere (Group 2). Multivariable regression analyses were conducted with variables that were significant at the univariate level. RESULTS Out of the 193 patients included, 22 (11%) failed to return home following IFR. Six variables were associated with failure to return home at the univariate level: longer acute length of stay (LOS), longer rehabilitation LOS, living alone, higher neurological level of injury, having comorbidities, and having a pressure injury (PI) during acute care. Three variables remained significant at the multivariate level: living alone, increasing acute LOS and presenting a high cervical (C1-C4) neurological level of injury. CONCLUSIONS It is important that acute care clinicians recognize the aforementioned factors early after TSCI in order to optimize patients for community reintegration.
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Affiliation(s)
- Antoine Dionne
- Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada.,Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, QC, H4J 1C5, Canada
| | - Victor Lim
- Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada. .,Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, QC, H4J 1C5, Canada. .,Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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Chan BCF, Cronin S, Jaglal SB, Craven BC. Publicly funded home care service use in the first 2 years after spinal cord injury in Ontario, Canada. Home Health Care Serv Q 2020; 39:95-106. [PMID: 32009576 DOI: 10.1080/01621424.2020.1723772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objectives of this study were to describe home care utilization and costs in community-dwelling individuals 2 years post-spinal cord injury (SCI) in Ontario, Canada. This retrospective incident cohort study uses administrative health care data to identify individuals with traumatic SCI (tSCI). Time to service delivery and frequency of service delivery and costs were calculated. A total of 798 individuals with tSCI comprised the cohort. In the first 2 years, personal support/homemaking was the most utilized service. Median cumulative home care 2 years post-discharge was $7,200 ($1,240-35,410 25-75% interquartile range). This study highlights the importance of home care to individuals with SCI.
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Affiliation(s)
- Brian Chun-Fai Chan
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Shawna Cronin
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Susan B Jaglal
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Beverley Catharine Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Beck B, Cameron PA, Braaf S, Nunn A, Fitzgerald MC, Judson RT, Teague WJ, Lennox A, Middleton JW, Harrison JE, Gabbe BJ. Traumatic spinal cord injury in Victoria, 2007-2016. Med J Aust 2020; 210:360-366. [PMID: 31055854 DOI: 10.5694/mja2.50143] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10-year period. DESIGN, SETTING, PARTICIPANTS Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007-2016. MAIN OUTCOMES AND MEASURES Temporal trends in population-based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more). RESULTS There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17-1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99-1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4-15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in-hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths). CONCLUSIONS Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post-discharge care, and support.
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Affiliation(s)
- Ben Beck
- Monash University, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Andrew Nunn
- Monash University, Melbourne, VIC.,Victorian Spinal Cord Service, Austin Hospital, Melbourne, VIC
| | - Mark C Fitzgerald
- The Alfred Hospital, Melbourne, VIC.,National Trauma Research Institute, Melbourne, VIC
| | - Rodney T Judson
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Warwick J Teague
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | | | - James W Middleton
- Kolling Institute, University of Sydney, Sydney, NSW.,Agency for Clinical Innovation, Sydney, NSW
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, SA
| | - Belinda J Gabbe
- Monash University, Melbourne, VIC.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Ravi B, Leroux T, Austin PC, Paterson JM, Aktar S, Redelmeier DA. Factors associated with emergency department presentation after total joint arthroplasty: a population-based retrospective cohort study. CMAJ Open 2020; 8:E26-E33. [PMID: 31992556 PMCID: PMC6996031 DOI: 10.9778/cmajo.20190116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unplanned visits to the emergency department after total joint arthroplasty are far more common than unplanned readmissions. Our objectives were to characterize the prevalence of presentation to an emergency department for any reason after total joint arthroplasty and to identify risk factors for such visits. METHODS Using health administrative databases, we conducted a population-based retrospective cohort study of adults (19-89 yr of age) who received their first primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) procedure for arthritis between April 2011 and March 2016 in Ontario. We made univariate comparisons between patients who presented to the emergency department within 30 days of surgery and those who did not in. We determined differences in use of health care services between groups by comparing the change in use in the year before and after surgery between patients who presented to the emergency department and those who did not. We developed logistic regression models for the occurrence of an emergency department visit using backward variable elimination. RESULTS We identified 42 273 total hip recipients and 70 725 total knee recipients, of whom 5640 (13.3%) and 11 224 (15.9%), respectively, presented to the emergency department within 30 days of surgery. Fewer than 1% of these patients required admission, and nearly half (45%) went to a different institution from where they had their surgery. Among both THA and TKA recipients, patients who presented to the emergency department had a net increase in their median annual health care costs (THA: $501, TKA: $682), compared to a net decrease for the cohort as a whole. Factors associated with increased risk of an emergency visit included increased patient age, male sex, rural residence and various comorbidities. Predictive regression models showed poor discriminative ability for both THA (C-statistic 0.57) and TKA (C-statistic 0.58) recipients. INTERPRETATION One in 7 patients presented to the emergency department within 30 days of THA or TKA. Some may conceivably have been managed remotely, and very few required readmission. There is a crucial need for strategies to minimize these events.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont.
| | - Timothy Leroux
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont
| | - Peter C Austin
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont
| | - J Michael Paterson
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont
| | - Suriya Aktar
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont
| | - Donald A Redelmeier
- Division of Orthopaedic Surgery (Ravi), Department of Surgery and Department of Medicine (Redelmeier), University of Toronto; Division of Orthopaedic Surgery (Ravi), Sunnybrook Health Sciences Centre; ICES (Ravi, Austin, Paterson, Aktar, Redelmeier); Division of Orthopaedic Surgery (Leroux), Toronto Western Hospital; Evaluative Clinical Sciences (Austin, Redelmeier), Sunnybrook Research Institute, Toronto, Ont
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Mollayeva T, Hurst M, Escobar M, Colantonio A. Sex-specific incident dementia in patients with central nervous system trauma. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2019; 11:355-367. [PMID: 31065582 PMCID: PMC6495080 DOI: 10.1016/j.dadm.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Despite evidence that central nervous system (CNS) trauma, including traumatic brain injury and spinal cord injury, can cause sustained neurocognitive impairment, it remains unclear whether trauma-related variables are associated with incident dementia independently of other known risk factors. METHODS All adults without dementia entering the health-care system with diagnoses of CNS trauma were examined for occurrence of dementia. All trauma-related variables were examined as predictors in sex-specific Cox regression models, controlling for other known risk factors. RESULTS Over a median follow-up of 52 months, 32,834 of 712,708 patients (4.6%) developed dementia. Traumatic brain injury severity and spinal cord injury interacted with age to influence dementia onset; women were at a greater risk of developing dementia earlier than men, all other factors being equal. DISCUSSION Risk stratification of patients with CNS trauma by sex is vital in identifying those most likely to develop dementia and in understanding the course and modifying factors.
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Affiliation(s)
- Tatyana Mollayeva
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
| | - Mackenzie Hurst
- Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Michael Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Ontario, Canada
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Li HL, Xu H, Li YL, Sun SW, Song WY, Wu Q, Ai J, Sun JC, Ning GZ, Feng SQ. Epidemiology of traumatic spinal cord injury in Tianjin, China: An 18-year retrospective study of 735 cases. J Spinal Cord Med 2019; 42:778-785. [PMID: 29323634 PMCID: PMC6830263 DOI: 10.1080/10790268.2017.1415418] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Study Design: Hospital-based retrospective studyObjectives: To evaluate the pathogenetic features of traumatic spinal cord injury (TSCI) during 1999-2016 according to changed injury etiology with time, explore different characteristics of patients suffered a TSCI during 1999-2007 and 2008-2016 in Tianjin, China.Setting: Tianjin Medical University General HospitalMethods: In this study, the medical records of TSCI patients were obtained from Tianjin Medical University General Hospital (TMUGH) from 1st January 1999 to 31th December 2016. Variables were recorded, including age, gender occupation, etiology, the level of injury, America Spinal Injury Association (ASIA) impairment scale, the severity, concomitant injuries, death and its cause. To explore the differences in characteristics by etiology and by two periods, related statistical methods were used to calculate the correlation of some variables. Differences in etiology of TSCI during 1999-2016 were evaluated and differences in epidemiological characteristics were separately compared and analyzed between the 1999-2007 period and the 2008-2016 period.Results: From 1999-2016, 831 TSCI cases were identified and 96 cases were excluded from analyses. The male-to-female ratio was 2.9:1 and the mean age was 49.7±15.2 years, which changed significantly between 1999-2007 (45.1±14.2) and 2008-2016 (51.6±15.2). Traffic accidents (45.8%) were the leading cause of TSCI during the 1999-2007 period, followed by low falls (30.7%). However, the opposite result was observed during the 2008-2016 period. Significant difference was observed compared with thoracic, lumbar and sacral levels, cervical level was the most commonly affected levels and the percentage decreased to a certain degree between 1999-2007 and 2008-2016 (from 84.4% to 68.9%). The proportions of ASIA grades A, B, C, and D were 20.5%, 10.3%, 23.3%, and 45.9%, respectively. The percentage of complete tetraplegia decreased from 22.9% in 1999-2007 to 13.2% in 2008-2016, and the percentage of incomplete paraplegia increased from 9.7% to 27.9%.Conclusion: According to the changes in the epidemiological characteristics of TSCI, relevant health service, laws and regulations, preventative strategies should be readjusted to follow up the changing situation and epidemiological characteristics of TSCI.
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Affiliation(s)
- Hai-Liang Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Hong Xu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yu-Lin Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Shi-Wei Sun
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Wen-Ye Song
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qiang Wu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jie Ai
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Jing-Cheng Sun
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Guang-Zhi Ning
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Shi-Qing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
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Rowan CP, Chan BCF, Jaglal SB, Catharine Craven B. Describing the current state of post-rehabilitation health system surveillance in Ontario - an invited review. J Spinal Cord Med 2019; 42:21-33. [PMID: 31573448 PMCID: PMC6781471 DOI: 10.1080/10790268.2019.1605724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury (SCI) presents numerous physiological, psychosocial, and environmental complexities resulting in significant healthcare system resource demands. Objective: To describe the current health system surveillance mechanisms in Ontario, Canada and highlight gaps in health surveillance among adults with SCI across their lifespan. Methods: A review of administrative data sources capturing SCI-specific information took place via internet searching and networking among SCI rehabilitation and health services experts with emphasis on functionality, health service utilization, and quality of life data. Results: The review identified a distinct paucity of data elements specific to the health surveillance needs of individuals with SCI living in the community. The gaps identified are: (1) a lack of data usability; (2) inadequate linkage between available datasets; (3) inadequate/infrequent reporting of outcomes; (4) a lack of relevant content/patient-reported outcomes; and, (5) failure to incorporate additional data sources (e.g. Insurance datasets). Conclusion: Currently, SCI-specific health data is disproportionately weighted towards the first 3-6 months post injury with detailed data regarding pre-hospital care, acute management and rehabilitation, but little existing infrastructure supporting community-based health surveillance. Given this reality, the bolstering of meaningful community health surveillance of this population across the lifespan is needed. Addressing the identified gaps in health surveillance must inform the creation of a comprehensive community health dataset incorporating patient-reported outcome measures and enabling linkage with existing administrative and/or clinical databases. A future harmonized data surveillance strategy would, in turn, positively impact function, health services, resource utilization and health-related quality of life surveillance.
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Affiliation(s)
- Chip P. Rowan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Correspondence to: Chip P. Rowan, Research Department, KITE, Toronto Rehab — University Health Network, Lyndhurst Centre, 520 Sutherland Dr, Toronto, Ontario, Canada M4G 3V9; Ph: 416-597-3422 x6217.
| | - Brian C. F. Chan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Gamblin A, Garry JG, Wilde HW, Reese JC, Sherrod B, Karsy M, Guan J, Mortenson J, Flis A, Rosenbluth JP, Bisson E, Dailey A. Cost Analysis of Inpatient Rehabilitation after Spinal Injury: A Retrospective Cohort Analysis. Cureus 2019; 11:e5747. [PMID: 31723508 PMCID: PMC6825436 DOI: 10.7759/cureus.5747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Objective The lifetime direct and indirect costs of spinal injury and spinal cord injury (SCI) increase as the severity of injury worsens. Despite the potential for substantial improvement in function with acute rehabilitation, the factors affecting its cost have not yet been evaluated. We used a proprietary hospital database to evaluate the direct costs of rehabilitation after spine injury. Methods A single-center, retrospective cohort cost analysis of patients with acute, traumatic spine injury treated at a tertiary facility from 2011 to 2017 was performed. Results In the 190 patients (mean age 46.1 ± 18.6 years, 76.3% males) identified, American Spinal Injury Association impairment scores on admission were 32.1% A, 14.7% B, 14.7% C, 33.2% D, and 1.1% E. Surgical treatment was performed in 179 (94.2%) cases. Most injuries were in the cervical spine (53.2%). A mean improvement of Functional Impairment Score of 30.7 ± 16.2 was seen after acute rehabilitation. Costs for care comprised facility (86.5%), pharmacy (9.2%), supplies (2.0%), laboratory (1.5%), and imaging (0.8%) categories. Injury level, injury severity, and prior inpatient surgical treatment did not affect the cost of rehabilitation. Higher injury severity (p = 0.0001, one-way ANOVA) and spinal level of injury (p = 0.001, one-way ANOVA) were associated with higher length of rehabilitation stay in univariate analysis. However, length of rehabilitation stay was the strongest independent predictor of higher-than-median cost (risk ratio = 1.56, 95% CI 1.21-2.0, p = 0.001) after adjusting for other factors. Conclusions Spine injury has a high upfront cost of care, with greater need for rehabilitation substantially affecting cost. Improving the efficacy of rehabilitation to reduce length of stay may be effective in reducing cost.
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Affiliation(s)
- Austin Gamblin
- Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Jason G Garry
- Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Herschel W Wilde
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Jared C Reese
- Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Brandon Sherrod
- Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Michael Karsy
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Jian Guan
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Janel Mortenson
- Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, USA
| | - Alexandra Flis
- Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, USA
| | | | - Erica Bisson
- Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Andrew Dailey
- Neurosurgery, University of Utah School of Medicine, Salt Lake City, USA
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Identifying Predictors of Higher Acute Care Costs for Patients With Traumatic Spinal Cord Injury and Modeling Acute Care Pathway Redesign: A Record Linkage Study. Spine (Phila Pa 1976) 2019; 44:E974-E983. [PMID: 30882757 DOI: 10.1097/brs.0000000000003021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Record linkage study using healthcare utilization and costs data. OBJECTIVE To identify predictors of higher acute-care treatment costs and length of stay for patients with traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA There are few current or population-based estimates of acute hospitalization costs, length of stay, and other outcomes for people with TSCI, on which to base future planning for specialist SCI health care services. METHODS Record linkage study using healthcare utilization and costs data; all patients aged more than or equal to 16 years with incident TSCI in the Australian state of New South Wales (June 2013-June 2016). Generalized Linear Model regression to identify predictors of higher acute care treatment costs for patients with TSCI. Scenario analysis quantified the proportionate cost impacts of patient pathway modification. RESULTS Five hundred thirty-four incident cases of TSCI (74% male). Total cost of all acute index episodes approximately AUD$40.5 (95% confidence interval [CI] ±4.5) million; median cost per patient was AUD$45,473 (Interquartile Range: $15,535-$94,612). Patient pathways varied; acute care was less costly for patients admitted directly to a specialist spinal cord injury unit (SCIU) compared with indirect transfer within 24 hours. Over half (53%) of all patients experienced at least one complication during acute admission; their care was less costly if they had been admitted directly to SCIU. Scenario analysis demonstrated that a reduction of indirect transfers to SCIU by 10% yielded overall cost savings of AUD$3.1 million; an average per patient saving of AUD$5,861. CONCLUSION Direct transfer to SCIU for patients with acute TSCI resulted in lower treatment costs, shorter length of stay, and less costly complications. Modeling showed that optimizing patient-care pathways can result in significant acute-care cost savings. Reducing potentially preventable complications would further reduce costs and improve longer-term patient outcomes. LEVEL OF EVIDENCE 3.
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[Conventional intubation and laryngeal tube in cervical spine instability : Changes in the width of the dural sac in unfixed human body donors]. Anaesthesist 2019; 68:509-515. [PMID: 31338524 DOI: 10.1007/s00101-019-0625-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Airway management in patients with an unstable cervical spine requires a cautious approach if secondary damage is to be prevented but the question regarding the optimum method remains unresolved. The primary aim of the study was to investigate whether there were differences between intubation by conventional Macintosh laryngoscopy and placement of a laryngeal tube (LTS-D) with respect to dural sac compression on an unfixed human cadaver model with unstable injuries of the upper cervical spine. Secondary parameters that could be relevant in patients with unstable spinal injuries were also investigated. MATERIAL AND METHODS Orotracheal intubation by conventional direct laryngoscopy using a Macintosh blade and placement of a laryngeal tube (LTS-D) were performed in six fresh human cadavers. The dural sac was filled with contrast dye to allow continuous myelography by lateral fluoroscopy. Changes in the width of the dural sac at the cervical segments (C) C0/C1 and the C1/C2 levels as well as secondary parameters (angulation, distraction, intervention time) were assessed in the intact spine as well as in the presence of combined atlanto-occipital dislocation and atlanto-axial instability. The intubation methods were considered independent and examined using the Mann-Whitney U‑test. RESULTS At the C0/C1 level in the intact spine, conventional laryngoscopy caused less reduction of the width of the dural sac than placement of the LTS-D (0.33 mm vs. 0.46 mm, p = 0.035); however, in the presence of combined atlanto-occipital dislocation and atlanto-axial instability, placement of the LTS-D caused less reduction in the width of the dural sac than conventional intubation (1.18 mm vs. 0.68 mm, p = 0.005). At the C1/C2 level no differences were found with respect to changes in the width of the dural sac, neither in the intact spine nor in combined atlanto-occipital dislocation and atlanto-axial instability. Conventional intubation caused more angulation than placement of the LTS-D at both levels measured. Both methods did not cause distraction. The intervention times for placement of the laryngeal tube were shorter. CONCLUSION In an unfixed human cadaver model with combined atlanto-occipital dislocation and atlanto-axial instability, placement of the LTS-D caused less reduction in the width of the dural sac than conventional intubation at the level of the craniocervical junction. The LTS-D also caused less angulation and could be placed faster. It could therefore also be advantageous over conventional intubation in living patients with an unstable cervical spine.
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Exploring the relationship between self-reported urinary tract infections to quality of life and associated conditions: insights from the spinal cord injury Community Survey. Spinal Cord 2019; 57:1040-1047. [PMID: 31289367 DOI: 10.1038/s41393-019-0323-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Descriptive study OBJECTIVES: Urinary tract infections (UTIs) are one of the most frequent types of infections following spinal cord injury (SCI). Here we assess the relationship between frequency of UTIs and activity level/overall quality of life (QOL) measures, determine the frequency of temporally associated conditions associated with UTI and identify factors associated with frequent UTIs. SETTING Canada METHODS: The Spinal Cord Injury Community Survey was developed to assess major dimensions of community living and health outcomes in persons with chronic SCI in Canada. Participants were stratified by self-reported UTI frequency. The relationship between UTI frequency and QOL, health resource utilization, and temporally associated conditions were assessed. Results were analysed with cross tabulations, χ2 tests, and ordinal logistic regression. RESULTS Overall 73.5% of participants experienced at least one self-reported UTI since the time of injury (mean 18.5 years). Overall QOL was worse with increasing frequency of these events. Those with frequent self-reported UTIs had twice as many hospitalizations and doctors' visits and were limited in financial, vocational and leisure situations, physical health and ability to manage self-care as compared with those with no UTIs. Self-reported UTIs were associated with higher incidence of temporally associated conditions including bowel incontinence, constipation, spasticity, and autonomic dysreflexia. Individuals who were younger and female were more likely to have frequent UTIs and those with constipation and autonomic dysreflexia had worse QOL. CONCLUSIONS Higher frequency self-reported UTIs is related to poor QOL of individuals with long-term SCI. These findings will be incorporated into SCI UTI surveillance and management guidelines.
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Rezaei M, Sharifi A, Vaccaro AR, Rahimi-Movaghar V. Home-Based Rehabilitation Programs: Promising Field to Maximize Function of Patients with Traumatic Spinal Cord Injury. Asian J Neurosurg 2019; 14:634-640. [PMID: 31497079 PMCID: PMC6703054 DOI: 10.4103/ajns.ajns_86_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (TSCI) has profound effects on the patient's health condition and function. However current treatment strategies fail in terms of cure. Thus, rehabilitative management has become the main gadget to promote patients' residual function. The most challenging aspect of rehabilitation is high costs of inpatient rehabilitation programs and poor continuity of care while patients are transferred to home. In this regard, numerous home based rehabilitation programs have been introduced. OBJECTIVES This review is an attempt to better introduce and classify different aspects of home care programs for patients with TSCI all around the world. METHODS A literature search was conducted in the PubMed, Medline, and Google Scholar database. Studies that addressed rehabilitative programs for patients with TSCI in their home or home-like facilities were reviewed. Reference lists from retrieved articles were also reviewed. RESULTS Home based rehabilitation can be categorized in five different but naturally relevant fields: home aids/modification, home nursing and family help, social support, home based primary care (multidisciplinary physician groups), and novel models/methods (e.g. "transitional rehabilitation" or telemedicine). CONCLUSION Since most investigators in TSCI home based rehabilitation have only introduced their findings, there are no comparative studies available. Thus future studies should be dedicated to clinical trials evaluating clinical efficacy of different strategies. A comprehensive integrated strategy with consideration to financial and other limitations should be applied to each specific area.
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Affiliation(s)
- Mojtaba Rezaei
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander Richard Vaccaro
- Department of Orthopedics and Neurosurgery, Thomas Jefferson University, The Rothman Institute, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Understanding and modelling the economic impact of spinal cord injuries in the United Kingdom. Spinal Cord 2019; 57:778-788. [PMID: 31086273 PMCID: PMC6760568 DOI: 10.1038/s41393-019-0285-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN Economic modelling analysis. OBJECTIVES To determine lifetime direct and indirect costs from initial hospitalisation of all expected new traumatic and non-traumatic spinal cord injuries (SCI) over 12 months. SETTING United Kingdom (UK). METHODS Incidence-based approach to assessing costs from a societal perspective, including immediate and ongoing health, rehabilitation and long-term care directly attributable to SCI, as well as aids and adaptations, unpaid informal care and participation in employment. The model accounts for differences in injury severity, gender, age at onset and life expectancy. RESULTS Lifetime costs for an expected 1270 new cases of SCI per annum conservatively estimated as £1.43 billion (2016 prices). This equates to a mean £1.12 million (median £0.72 million) per SCI case, ranging from £0.47 million (median £0.40 million) for an AIS grade D injury to £1.87 million (median £1.95 million) for tetraplegia AIS A-C grade injuries. Seventy-one percent of lifetime costs potentially are paid by the public purse with remaining costs due to reduced employment and carer time. CONCLUSIONS Despite the magnitude of costs, and being comparable with international estimates, this first analysis of SCI costs in the UK is likely to be conservative. Findings are particularly sensitive to the level and costs of long-term home and residential care. The analysis demonstrates how modelling can be used to highlight economic impacts of SCI rapidly to policymakers, illustrate how changes in future patterns of injury influence costs and help inform future economic evaluations of actions to prevent and/or reduce the impact of SCIs.
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Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing Complications and Costs of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fractures: A Propensity Score-Matched, Population-Based Study. J Bone Joint Surg Am 2019; 101:572-579. [PMID: 30946190 DOI: 10.2106/jbjs.18.00539] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the prevalence of displaced femoral neck fractures in the elderly population is increasing worldwide, there remains controversy as to whether these injuries should be managed with hemiarthroplasty or total hip arthroplasty. Although total hip arthroplasties result in better function, they are more expensive and may have higher complication rates. Our objective was to compare the complication rates and health-care costs between hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the elderly population. METHODS A population-based, retrospective cohort study was performed on adults (≥60 years of age) undergoing either hemiarthroplasty or total hip arthroplasty for hip fracture between April 1, 2004, and March 31, 2014. We excluded patients who resided in long-term care facilities prior to the injury and those who were discharged to these facilities after the surgical procedure. Patients who underwent a hemiarthroplasty and those who underwent a total hip arthroplasty were matched using a propensity score encompassing patient demographic characteristics, patient comorbidities, and provider factors. After matching, we compared the rates of medical and surgical complications, as well as the perioperative and postoperative health-care costs in the year following the surgical procedure. The primary outcome was the occurrence of a medical complication (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, ileus, pneumonia, renal failure) within 90 days or a surgical complication (dislocation, infection, revision surgical procedure) within 1 year. Additionally, we examined the change in health-care costs in the year following the surgical procedure, including costs associated with the index admission, relative to the year before the surgical procedure. RESULTS Among 29,121 eligible patients, 2,713 (9.3%) underwent a total hip arthroplasty. After successfully matching 2,689 patients who underwent a total hip arthroplasty with those who underwent a hemiarthroplasty, the patients who underwent a total hip arthroplasty were at an increased risk for dislocation (1.7% compared with 1.0%; p = 0.02), but were at a decreased risk for revision (0.2% compared with 1.8%; p < 0.0001), relative to patients who underwent a hemiarthroplasty. Furthermore, the overall increase in the annual health-care expenditure in the year following the surgical procedure was approximately $2,700 in Canadian dollars lower in patients who underwent a total hip arthroplasty (p < 0.001). CONCLUSIONS Among elderly patients with displaced femoral neck fractures, total hip arthroplasty was associated with lower rates of revision surgical procedures and reduced health-care costs during the index admission and in the year following the surgical procedure, relative to hemiarthroplasty. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hayat Khan
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Hans J Kreder
- Division of Orthopaedic Surgery, Department of Surgery (B.R., D.P., H.K., D.W., R.J., and H.J.K.), and Institute of Health Policy, Management and Evaluation (D.P. and H.J.K.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Scivoletto G, Galli G, Torre M, Molinari M, Pazzaglia M. The Overlooked Outcome Measure for Spinal Cord Injury: Use of Assistive Devices. Front Neurol 2019; 10:272. [PMID: 30967836 PMCID: PMC6438886 DOI: 10.3389/fneur.2019.00272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Galli
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Monica Torre
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Molinari
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariella Pazzaglia
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, La Sapienza University of Rome, Rome, Italy
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Chan BCF, Cadarette SM, Wodchis WP, Krahn MD, Mittmann N. The lifetime cost of spinal cord injury in Ontario, Canada: A population-based study from the perspective of the public health care payer. J Spinal Cord Med 2019; 42:184-193. [PMID: 29923798 PMCID: PMC6419658 DOI: 10.1080/10790268.2018.1486622] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To determine the publicly funded health care system lifetime cost-of-illness of spinal cord injury (SCI) from the perspective of the Ontario Ministry of Health and Long-term Care. METHODS Individuals hospitalized for their first SCI between the years 2005 and 2011 were identified and their health care costs were calculated using Ontario administrative health care data. From this information, lifetime costs were estimated using phase-based costing methods. The spinal cord injured cohort was matched to a non-spinal cord injured using propensity score matching. Net costs were determined by calculating the difference in costs between the two matched groups. Net costs were also presented for subgroups stratified by demographic characteristics. RESULTS A total of 1,716 individuals with SCI were identified and matched in our study. The net lifetime cost of SCI was $336,000 per person. Much of the costs were observed in the first year post-SCI. The lifetime cost of SCI for individuals with a concurrent pressure ulcer at the initial hospitalization rises to $479,600. Costs were also higher for individuals with cervical or thoracic injury or requiring inpatient rehabilitation. CONCLUSIONS Spinal cord injury is a substantial burden to the health care system. Our results are limited to the direct health care costs from the publicly funded health care payer perspective. Further analysis with a broader perspective is needed to understand the full economic impact of this catastrophic condition.
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Affiliation(s)
| | - Suzanne M. Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Murray D. Krahn
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
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Garbens A, Wallis CJD, Matta R, Kodama R, Herschorn S, Narod S, Nam RK. The cost of treatment and its related complications for men who receive surgery or radiation therapy for prostate cancer. Can Urol Assoc J 2018; 13:E236-E248. [PMID: 30526806 DOI: 10.5489/cuaj.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to examine the costs related to treatment and treatment-related complications for patients treated with surgery or radiation for localized prostate cancer. METHODS We performed a population-based, retrospective cohort study of men who underwent open radical prostatectomy or radiation from 2004-2009 in Ontario, Canada. Costs, including initial treatment and inpatient hospitalization, emergency room visit, outpatient consultation, physician billings, and medication costs, were determined for five years following treatment using a validated costing algorithm. Multivariable negative binomial regression was used to assess the association between treatment modality and costs. RESULTS A total of 28 849 men underwent treatment for localized prostate cancer from 2004- 2009. In the five years following treatment, men who underwent radiation (n=12 675) had 21% higher total treatment and treatment-related costs than men who underwent surgery ($16 716/person vs. $13 213/person). Based on multivariable analysis, while men who underwent XRT had a lower relative cost in their first year after treatment (relative rate [RR] 0.97; 95% confidence interval [CI] 0.94-1.0; p=0.025), after year 2, annual costs were significantly higher in the radiation group compared to the surgery group (total cost for year 5, RR 1.44; 95% CI 1.17-1.76; p<0.0001). Our results were similar when restricted to young, healthy men and to older men. CONCLUSIONS Men who undergo radiation have significantly higher five-year total treatment-related costs compared to men who undergo open radical prostatectomy. While surgery was associated with slightly higher initial costs, radiotherapy had higher costs in subsequent years.
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Affiliation(s)
- Alaina Garbens
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
| | - Steven Narod
- Women's College Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Center, University of Toronto, ON, Canada
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Vaikuntam BP, Middleton JW, McElduff P, Pearse J, Walsh J, Cameron ID, Sharwood LN. Assessing the impact of care pathways on potentially preventable complications and costs for spinal trauma patients: protocol for a data linkage study using cohort study and administrative data. BMJ Open 2018; 8:e023785. [PMID: 30413515 PMCID: PMC6231591 DOI: 10.1136/bmjopen-2018-023785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Traumatic spinal cord injuries have significant consequences both for the injured individual and the healthcare system, usually resulting in lifelong disability. Evidence has shown that timely medical and surgical interventions can lead to better patient outcomes with implicit cost savings. Potentially preventable secondary complications are therefore indicators of the effectiveness of acute care following traumatic injury. The extent to which policy and clinical variation within the healthcare service impact on outcomes and acute care costs for patients with traumatic spinal cord injury (TSCI) in Australia is not well described. METHODS AND ANALYSIS A comprehensive data set will be formed using record linkage to combine patient health and administrative records from seven minimum data collections (including costs), with an existing data set of patients with acute TSCI (Access to Care Study), for the time period June 2013 to June 2016. This person-level data set will be analysed to estimate the acute care treatment costs of TSCI in New South Wales, extrapolated nationally. Subgroup analyses will describe the associated costs of secondary complications and regression analysis will identify drivers of higher treatment costs. Mapping patient care and health service pathways of these patients will enable measurement of deviations from best practice care standards and cost-effectiveness analyses of the different pathways. ETHICS AND DISSEMINATION Ethics approval has been obtained from the New South Wales Population and Health Services Research Ethics Committee. Dissemination strategies include peer-reviewed publications in scientific journals and conference presentations to enable translation of study findings to clinical and policy audiences.
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Affiliation(s)
- Bharat Phani Vaikuntam
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - James W Middleton
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
- Agency for Clinical Innovation, NSW Statewide Spinal Cord Injury Service, Sydney, New South Wales, Australia
| | | | - Jim Pearse
- Health Policy Analysis, Sydney, New South Wales, Australia
| | - John Walsh
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - Ian D Cameron
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
| | - Lisa Nicole Sharwood
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, John Walsh Centre for Rehabilitation Research, Sydney, New South Wales, Australia
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Pincus D, Wasserstein D, Ravi B, Huang A, Paterson JM, Jenkinson RJ, Kreder HJ, Nathens AB, Wodchis WP. Medical Costs of Delayed Hip Fracture Surgery. J Bone Joint Surg Am 2018; 100:1387-1396. [PMID: 30106820 DOI: 10.2106/jbjs.17.01147] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Waiting for hip fracture surgery is associated with complications. The objective of this study was to determine whether waiting for hip fracture surgery is associated with health-care costs. METHODS We conducted a population-based, propensity-matched cohort study of patients treated between 2009 and 2014 in Ontario, Canada. The primary exposure was early hip fracture surgery, performed within 24 hours after arrival at the emergency department. The primary outcome was direct medical costs, estimated for each patient in 2013 Canadian dollars, from the payer perspective. The costs in the early and delayed groups were then compared using a difference-in-differences approach: the baseline cost in the year prior to the hip fracture that had been accrued by patients with early surgery was subtracted from the cost in the first year following the surgery (first difference), and the difference was then compared with the same difference among propensity-score-matched patients who had received delayed surgery (second difference). The secondary outcome was the postoperative length of stay (in days). RESULTS The study included 42,230 patients who received hip fracture surgery from a total of 522 different surgeons at 72 hospitals. The mean cost (and standard deviation) attributed to the hip fracture was $39,497 ± $46,645 per person. The matched patients who underwent surgery after 24 hours had direct 1-year medical costs that were an average of $2,638 higher (95% confidence interval [CI] = $1,595 to $3,680, p < 0.0001) and a postoperative length of stay that was an average of 0.610 day longer (95% CI = 0.1749 to 1.0331 days, p = 0.0058) compared with those who underwent surgery within 24 hours. CONCLUSIONS Waiting >24 hours for hip fracture surgery was associated with increased medical costs and length of stay. Costs incurred by waiting may provide a financial incentive to mitigate delays in hip fracture surgery. LEVEL OF EVIDENCE Economic Level III. Please see Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anjie Huang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Richard J Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hans J Kreder
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Avery B Nathens
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Division of Orthopaedic Surgery, Department of Surgery (D.P., D.W., B.R., R.J.J., H.J.K., and A.B.N.) and the Institute of Health Policy, Management and Evaluation (D.P., R.J.J., H.J.K., A.B.N., and W.P.W.), University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
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