Clinical characteristics, hospital course, and disposition of patients with nontraumatic spinal cord injury in a large private health care system in the United States.

IF 3.7 1区 经济学 Q1 ECONOMICS Review of International Political Economy Pub Date : 2023-11-01 Epub Date: 2022-05-09 DOI:10.1080/10790268.2022.2069533
Se Won Lee, Bryan Werner, Jonathan Holt, Akash Lohia, Napatkamon Ayutyanont, Henry York
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引用次数: 1

Abstract

Objectives: To evaluate the clinical characteristics, hospital courses, outcomes after hospitalization, and factors associated with outcomes in patients with nontraumatic spinal cord injuries (NTSCI).

Design: Retrospective analysis.

Setting: A large for-profit United States health care system.

Participants: 2807 inpatients with NTSCI between 2014 and 2020 were identified using International Classification of Disease codes.

Main outcome measure: Demographic, clinical characteristics, hospital course, and disposition data collected from electronic health record.

Results: The mean age was 57.91 ± 16.41 years with 69.83% being male. Incomplete cervical level injury was the most common injury type, spinal stenosis was the most common diagnostic etiology and central cord syndrome was the most common clinical syndrome. The average length of stay was 9.52 ± 15.8 days, with the subgroup of 1308 (46.6%) patients who were discharged home demonstrating a shorter length of stay (6.42 ± 10.24 days). Falls were the most common hospital-acquired complication (n = 424, 15.11%) and 83 patients deceased. There were increased odds of non-home discharge among patients with the following characteristics: older age, Medicare insurance, non-black racial minority, increased Charlson Comorbidity Index (CCI), intensive care unit (ICU) stay, use of steroid or anticoagulant medications, and hospital-acquired pulmonary complications. Increased in-hospital mortality was observed in those with Medicaid insurance, ICU stay, increased CCI, diagnosis of degenerative spine disease, other unspecified level of injury, and hospital-acquired pulmonary complications.

Conclusions: NTSCI in this sample were predominantly incomplete cervical central SCIs. Increased CCI, ICU stay, and hospital-acquired pulmonary complications were associated with poorer outcomes after acute care hospitalization among patients with NTSCI.

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美国大型私人医疗系统中非创伤性脊髓损伤患者的临床特征、住院过程和处置。
目的:评价非创伤性脊髓损伤(NTSCI)患者的临床特征、住院过程、住院后的预后以及与预后相关的因素。设计:回顾性分析。背景:美国大型营利性医疗保健系统。参与者:使用国际疾病分类代码识别2014年至2020年期间2807例住院NTSCI患者。主要结果测量:从电子健康记录中收集的人口学、临床特征、住院过程和处置数据。结果:平均年龄57.91±16.41岁,男性占69.83%。不完全颈椎水平损伤是最常见的损伤类型,椎管狭窄是最常见的诊断病因,脊髓中央综合征是最常见的临床综合征。平均住院时间为9.52±15.8 d,其中出院1308例(46.6%)患者住院时间较短(6.42±10.24 d)。跌倒是最常见的医院获得性并发症(n = 424, 15.11%),死亡83例。具有以下特征的患者非家庭出院的几率增加:年龄较大,医疗保险,非黑人少数民族,Charlson合并症指数(CCI)增加,重症监护病房(ICU)住院,使用类固醇或抗凝药物,以及医院获得性肺部并发症。在医疗补助保险、ICU住院、CCI增加、诊断为退行性脊柱疾病、其他未明确程度的损伤和医院获得性肺部并发症的患者中,观察到住院死亡率增加。结论:本病例中NTSCI主要为不完全性颈椎中枢性sci。增加的CCI、ICU住院时间和医院获得性肺部并发症与NTSCI患者急性住院治疗后较差的预后相关。
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来源期刊
CiteScore
9.20
自引率
9.30%
发文量
47
期刊介绍: The Review of Political Economy is a peer-reviewed journal welcoming constructive and critical contributions in all areas of political economy, including the Austrian, Behavioral Economics, Feminist Economics, Institutionalist, Marxian, Post Keynesian, and Sraffian traditions. The Review publishes both theoretical and empirical research, and is also open to submissions in methodology, economic history and the history of economic thought that cast light on issues of contemporary relevance in political economy. Comments on articles published in the Review are encouraged.
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