Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Spinal Cord. 2010 Jan;48(1):45-50. doi: 10.1038/sc.2009.78. Epub 2009 Jun 23.


Study design: Retrospective cohort design.

Objectives: To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation.

Setting: Ontario, Canada.

Methods: Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization.

Results: NTSCI cases (n=1002) were greater than TSCI (n=560). NTSCIs were older (mean=61.6, s.d.=15.8) with more co-morbidities, paraplegic (39.5%) and female (P<0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median=24) and 29.7 (median=22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR=1.5; 95% CI=1.2-1.9), urban living (OR=1.59; 95% CI=1.12-2.22) and lowest quartile (18-88) discharge FIM (OR=1.8; 95% CI=1.4-2.3). Charlson score of 3 or more (OR=2.1; 95% CI=1.3-3.2), urban living (OR=1.92; 95% CI=1.3-2.86) and lowest quartile discharge FIM (OR=1.5; 95% CI=1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR=1.5; 95% CI=1.1-2.1), low income (OR=1.4; 95% CI=1.1-1.9) and low (18-88) discharge FIM (OR=1.7; 95% CI=1.3-2.2).

Conclusion: Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Community Health Planning
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Hospital Mortality
  • Humans
  • Insurance, Health / statistics & numerical data
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Morbidity
  • Ontario / epidemiology
  • Paraplegia / rehabilitation
  • Rehabilitation Centers
  • Retrospective Studies
  • Severity of Illness Index
  • Socioeconomic Factors
  • Spinal Cord Injuries / classification
  • Spinal Cord Injuries / epidemiology*
  • Spinal Cord Injuries / rehabilitation*
  • Statistics, Nonparametric