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Emergency Department Visits, Related Hospitalizations, and Reasons for Emergency Department Utilization After Traumatic Spinal Cord Injury

      Abstract

      Objective

      To identify the self-reported frequency of emergency department (ED) visits, ED-related hospitalizations, and reasons for ED visits among people with traumatic spinal cord injury (SCI) and compare them with general population data from the same geographic area.

      Design

      Cross-sectional.

      Setting

      A specialty hospital in the Southeastern United States.

      Participants

      The participants (N=648) were community-dwelling adults (18 years and older) with a traumatic SCI, who were at least 1 year postinjury. A comparison group of 9728 individuals from the general population was retrieved from the 2017 National Health Interview Survey (NHIS).

      Interventions

      Not applicable.

      Main Outcome Measures

      Participants completed self-report assessments on ED visits, ED hospitalizations, and reasons for ED visits in the past 12 months using items from the NHIS.

      Results

      A total of 37% of participants with SCI reported at least 1 ED visit, and 18% reported at least 1 ED hospitalization in the past 12 months. Among those having at least 1 ED visit, 49% were admitted to hospitals. After controlling for sex, age, and race/ethnicity, participants with SCI were 151% more likely to visit the ED (odds ratio [OR], 2.51) and 249% more likely to have at least 1 ED hospitalization than the NHIS sample (OR, 3.49). Persons with SCI had a higher percentage of ED visits because of severe health conditions, reported an ED was the closest provider, and were more likely to arrive by ambulance. NHIS participants were more likely to visit the ED because no other option was available.

      Conclusions

      Compared with those in the general population, individuals with SCI have substantially higher rates of ED visits, yet ED visits are not regularly assessed within the SCI Model Systems. ED visits may indicate the need for intervention beyond the acute condition leading directly to the ED visits and an opportunity to link individuals with resources needed to maintain function in the community.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), ED (emergency department), NHIS (National Health Interview Survey), OR (odds ratio), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), US (United States)
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      References

        • National Spinal Cord Injury Statistical Center
        Spinal cord injury facts and figures at a glance.
        University of Alabama at Birmingham, Birmingham2020
        • Guilcher SJ
        • Munce SE
        • Couris CM
        • et al.
        Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study.
        Spinal Cord. 2010; 48: 45-50
        • Guilcher SJ
        • Craven BC
        • Calzavara A
        • McColl MA
        • Jaglal SB.
        Is the emergency department an appropriate substitute for primary care for persons with traumatic spinal cord injury?.
        Spinal Cord. 2013; 51: 202-208
        • Hamilton R
        • Driver S
        • Noorani S
        • Callender L
        • Bennett M
        • Monden K
        Utilization and access to healthcare services among community-dwelling people living with spinal cord injury.
        J Spinal Cord Med. 2017; 40: 321-328
        • National Spinal Cord Injury Statistical Center
        2019 Annual statistical report.
        University of Alabama at Birmingham, Birmingham2019
        • Krause JS
        • Terza JV
        • Cao Y
        • Clark JM
        Emergency room visits and hospitalizations among participants with spinal cord injury.
        NeuroRehabilitation. 2015; 36: 313-321
        • Saunders LL
        • Murday D
        • Corley E
        • Cao Y
        • Krause JS
        Comparison of rates of hospitalization and emergency department visits using self-report and South Carolina administrative billing data among a population-based cohort with spinal cord injury.
        Arch Phys Med Rehabil. 2016; 97: 1481-1486
        • Skelton F
        • Hoffman JM
        • Reyes M
        • Burns SP
        Examining health-care utilization in the first year following spinal cord injury.
        J Spinal Cord Med. 2015; 38: 690-695
        • Sikka S
        • Callender L
        • Driver S
        • et al.
        Healthcare utilization following spinal cord injury: objective findings from a regional hospital registry.
        J Spinal Cord Med. 2019; 42: 194-200
        • Cai S
        • Bakerjian D
        • Bang H
        • Mahajan SM
        • Ota D
        • Kiratli J
        Data acquisition process for VA and non-VA emergency department and hospital utilization by veterans with spinal cord injury and disorders in California using VA and state data.
        J Spinal Cord Med. 2020 Jun 16; ([Epub ahead of print])
        • Gabbe BJ
        • Nunn A
        Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury.
        Injury. 2016; 47: 1847-1855
        • Stillman MD
        • Frost KL
        • Smalley C
        • Bertocci G
        • Williams S
        Health care utilization and barriers experienced by individuals with spinal cord injury.
        Arch Phys Med Rehabil. 2014; 95: 1114-1126
      1. National Center for Health Statistics. Health, United States, 2018. Hyattsville; 2019.

      2. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. Available at:https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf. Accessed January 24, 2021.

        • Skelton F
        • Salemi JL
        • Akpati L
        • et al.
        Genitourinary complications are a leading and expensive cause of emergency department and inpatient encounters for persons with spinal cord injury.
        Arch Phys Med Rehabil. 2019; 100: 1614-1621
        • Munce SE
        • Guilcher SJ
        • Couris CM
        • et al.
        Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study.
        Spinal Cord. 2009; 47: 470-476
        • Meyers AR
        • Branch LG
        • Cupples LA
        • Lederman RI
        • Feltin M
        • Master RJ
        Predictors of medical care utilization by independently living adults with spinal cord injuries.
        Arch Phys Med Rehabil. 1989; 70: 471-476
        • SCIMS
        Data collection syllabus for the National Spinal Cord Injury Database.
        National Spinal Cord Injury Statistical Center, Birmingham, AL2010
        • Chen Y
        • DeVivo MJ
        • Richards JS
        • SanAgustin TB
        Spinal Cord Injury Model Systems: review of program and national database from 1970 to 2015.
        Arch Phys Med Rehabil. 2016; 97: 1797-1804
      3. NHIS. National Health Interview Survey Questionnaire. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2013/english/qadult.pdf. Accessed January 24, 2021.

        • Dejong G
        • Hoffman J
        • Meade M
        • et al.
        Postrehabilitative health care for individuals with SCI: extending health care into the community.
        Top Spinal Cord Inj Rehabil. 2011; 17: 46-58
        • Houlihan BV
        • Everhart-Skeels S
        • Gutnick D
        • et al.
        Empowering adults with chronic spinal cord injury to prevent secondary conditions.
        Arch Phys Med Rehabil. 2016; 97: 1687-1695
        • Houlihan BV
        • Brody M
        • Everhart-Skeels S
        • et al.
        Randomized trial of a peer-led, telephone-based empowerment intervention for persons with chronic spinal cord injury improves health self-management.
        Arch Phys Med Rehabil. 2017; 98: 1067-1076
        • Tomasone JR
        • Arbour-Nicitopoulos KP
        • Latimer-Cheung AE
        • Martin Ginis KA
        The relationship between the implementation and effectiveness of a nationwide physical activity telephone counseling service for adults with spinal cord injury.
        Disabil Rehabil. 2018; 40: 527-537
        • Phillips VL
        • Vesmarovich S
        • Hauber R
        • Wiggers E
        • Egner A
        Telehealth: reaching out to newly injured spinal cord patients.
        Public Health Rep. 2001; 116: 94-102
        • Lai B
        • Rimmer J
        • Barstow B
        • Jovanov E
        • Bickel CS
        Teleexercise for persons with spinal cord injury: a mixed-methods feasibility case series.
        JMIR Rehabil Assist Technol. 2016; 3: e8
        • Allin S
        • Shepherd J
        • Thorson T
        • et al.
        Web-based health coaching for spinal cord injury: results from a mixed methods feasibility evaluation.
        JMIR Rehabil Assist Technol. 2020; 7: e16351
        • Ho C
        • Atchison K
        • Noonan VK
        • et al.
        Models of care delivery from rehabilitation to community for spinal cord injury: a scoping review.
        J Neurotrauma. 2021; 38: 677-697