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Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome

Abstract

Study design

Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation.

Objectives

To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination.

Setting

Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions.

Methods

All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors.

Results

Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission.

Conclusions

Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.

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Data availability

Data are included in the registry of 2012 CCM project according to national privacy regulations and are available by a formal request to the Emilia-Romagna Regional Health Authority.

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Acknowledgements

CCM is the National Center for Diseases prevention and Control whose task is to liaise with the Ministry of Health and the regional governments as far as surveillance and prevention are concerned and whose aim is to promptly respond to emergencies. http://www.ccm-network.it/progetto.jsp?id=node/1846&idP=740.

Collaborating Hospitals and Regional Health Authorities

M.V. Actis, M. Stillittano (Città della Salute e della Scienza Hospital, Turin); S. Petrozzino (Alessandria Hospital); C. Cisari (Novara Hospital), M. Salvini (Piedmont Region); T. Redaelli, R. Tosi (Niguarda Hospital, Milano); C.M. Borghi, A. Bava (Pini CTO Hospital, Milano); C. Pistarini, (IRCCS Maugeri Foundation, Pavia); G. Molinero, A. Signorelli (Bergamo Hospital); S. Sandri (Legnano- Magenta Hospital); F. Simeoni (Garbagnate Hospital); M. Brambilla (Valtellina Hospital) M.A. Banchero, A. Olivero, G. Zanaboni (Lombardy Region); R. Avesani (Don Calabria Hospital, Negrar, Verona); G. Bertagnoni, M. Leucci, L. Lain (S. Bortolo Hospital, Vicenza); M. Saia (Veneto Region); A. Zampa (Gervasutta Hospital, Udine); P. Del Fabro (Udine Hospital); M. Saccavini (Palmanova Hospital, Udine); A. Fanzutto (Friuli Venezia Giulia Region); A. Massone (Santa Corona Hospital, Pietra Ligure, Savona); J. Bonavita, D. Gaddoni, S. Olivi, G. Musumeci, R. Pederzini (Montecatone Rehabilitation Institute, Imola, Bologna); H. Cerrel Bazo, D. Nicolotti, (Villanova d’Arda Hospital, Piacenza); M. Nora, R. Brianti, C. Iaccarino, A. Volpi (Parma Hospital); A. Lombardi, S. Cavazza, F. Casoni (Baggiovara Hospital, Modena); F. De Iure, G. Gordini, R. Piperno (Maggiore Hospital, Bologna); G. Teodorani, A. Naldi, G. Vergoni, (Cesena Hospital); E. Maietti, A. Botti (Ferrara Hospital); S. Ferro, G. Pagoto (Emilia-Romagna Region); G. Del Popolo, M. Moresi, M. Postiglione, C. Bini (Careggi Hospital, Firenze); M. Tagliaferri (Tuscany Region); M. A. Recchioni, P. Pelaia (Ospedali Riuniti, Ancona); L. Di Furia (Marche Region); M.C. Pagliacci, R. Maschke, L. Caruso, L. Speziali (Perugia Hospital); M. Zenzeri (Umbria Region); P. Fiore, R. Marvulli (Bari Hospital); R. Nardulli (IRCCS Maugeri Foundation, Cassano Murge, Bari); C. Lanzillotti (IRCCS Maugeri Foundation, Ceglie Messapica, Brindisi); M. Ruccia (Puglia Region); M.P. Onesta, T. Di Gregorio (Cannizzaro Hospital, Catania); F. Franchina (Villa Sofia Hospital, Palermo); M.G. Furnari (Sicily Region); C. Pilati, M. Merafina, F. Crescia (Alesini CTO Hospital, Rome); D. Fletzer (Ostia Hospital, Rome); G. Scivoletto (IRCCS S. Lucia Foundation, Rome); N. Di Lallo (Lazio Region).

Funding

This study was financed within the framework of the 2012 CCM program.

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Contributions

MF participated in the scientific coordination of the project and contributed to writing the report. JB coordinated data collection and contributed to writing the report. LC conducted the statistical analyses and contributed to writing the report. SF coordinated all scientific aspects of the research project. MCP coordinated data collection and contributed to writing the report.

Corresponding author

Correspondence to Jacopo Bonavita.

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We certify that all applicable institutional and governmental regulations concerning the ethical use of data originally collected for clinical purpose were followed during the course of this research.

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Franceschini, M., Bonavita, J., Cecconi, L. et al. Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord 58, 768–777 (2020). https://doi.org/10.1038/s41393-020-0421-y

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