Article

OBJECTIVE: To determine the incidence of venous thromboembolism (VTE) among
patients with traumatic spinal cord injury (TSCI) in acute care settings that is
attributable to extended length of stay (LOS), insurance status, and access to
rehabilitation. DESIGN: Population-based, retrospective cohort study. SETTING:
Levels I through III and undesignated trauma centers. PARTICIPANTS: Patients with
acute TSCI (N=3389) discharged from all acute care hospitals in South Carolina
from 1998 through 2009, and a representative sample of patients with TSCI (n=186)
interviewed 1 year later. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE:
VTE while in acute care. RESULTS: Annual incidence of TSCI is 67.2 per million in
the state of South Carolina, while the cumulative incidence of VTE is 4.1%.
Patients with TSCI who developed VTE were nearly 4 times more likely (odds ratio
[OR], 3.98; 95% confidence interval [CI], 2.57-6.17) to have been those who
stayed 12 days or longer in acute care after adjusting for covariates. The
adjusted mean LOS in acute care was 32.0 days (95% CI, 27.7-37.2) for patients
with TSCI who had indigent insurance versus 11.3 days (95% CI, 4.9-17.6) for
Medicare, and 18.5 days (95% CI, 14.5-22.5) for commercial insurance after
adjusting for VTE, disposition, and year of discharge. Only 20% of the persons
under indigent care received rehabilitation from accredited rehabilitation
facilities in contrast to 60% under commercial insurance. CONCLUSIONS: Fewer
patients with TSCI under indigent care received postacute rehabilitation compared
with Medicare or commercial insurance. Insurance status remains a major barrier
to timely transfer to rehabilitation, leading to protracted LOS in acute care
with increased risk of VTE.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS