BMC Health Services Research | |
Right care, right time, right place: improving outcomes for people with spinal cord injury through early access to intervention and improved access to specialised care: study protocol | |
Sarah Healy5  Sandy Muecke6  Karen Smith2  Rod McClure4  Doug Brown5  James E Harrison1  Paul M Middleton7  Peter Cameron8  Lisa N Sharwood3  James M Middleton3  | |
[1] Research Centre for Injury Studies, Flinders University, South Australia, Australia;Ambulance Victoria, Research and Evaluation, Melbourne, Australia;John Walsh Centre for Rehabilitation Research, Sydney, Australia;Harvard School of Public Health, Harvard Injury Control Research Centre, Boston, USA;The Spinal Research Institute, Melbourne, Australia;NSW Ambulance, New South Wales, Australia;Discipline of Emergency Medicine, University of Sydney, New South Wales, Australia;Department of Preventive Medicine, Monash University, Melbourne, Australia | |
关键词: Outcomes; Quality of care; Access to specialist care; Trauma systems; Patient flow; Clinical pathways; Acute traumatic spinal cord injury; | |
Others : 1090199 DOI : 10.1186/s12913-014-0600-7 |
|
received in 2014-09-01, accepted in 2014-11-12, 发布年份 2014 | |
【 摘 要 】
Background
Traumatic spinal cord injury is a devastating condition impacting adversely on the health and wellbeing, functioning and independence, social participation and quality of life of the injured person. In Australia, there are approximately 15 new cases per million population per year; economic burden estimates suggest 2 billion dollars annually. For optimal patient outcomes expert consensus recommends expeditious transfer (“<24 hours of injury”) to a specialist Spinal Cord Injury Unit, where there is an interdisciplinary team equipped to provide comprehensive care for the many and complex issues associated with traumatic spinal cord injury. No study of this patient population has been undertaken, that assessed the extent to which care received reflected clinical guidelines, or examined the patient journey and outcomes in relation to this. The aims of this study are to describe the nature and timing of events occurring before commencement of specialist care, and to quantify the association between these events and patient outcomes.
Methods and design
The proposed observational study will recruit a prospective cohort over two years, identified at participating sites across two Australian states; Victoria and New South Wales. Included participants will be aged 16 years and older and diagnosed with a traumatic spinal cord injury. Detailed data will be collected from the point of injury through acute care and subacute rehabilitation, discharge from hospital and community reintegration. Items will include date, time, location and external cause of injury; ambulance response, assessments and management; all episodes of hospital care including assessments, vital signs, diagnoses and treatment, inter-hospital transfers, surgical interventions and their timing, lengths of stay and complications. Telephone follow-up of survivors will be conducted at 6, 12 and 24 months.
Discussion
There is limited population level data on the effect of delayed commencement of specialist care (>24 hours) in a Spinal Cord Injury Unit. Examining current health service and clinical intervention pathways in this Australian population-based sample, in relation to their outcomes, will provide an understanding of factors associated with patient flow, resource utilisation and cost, and patient and family quality of life. Barriers to streamlined effective early-care pathways and facilitators of optimal treatment for these patients will be identified.
【 授权许可】
2014 Middleton et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150128154832642.pdf | 272KB | download | |
Figure 1. | 23KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Kwon BK, Sekhon LH, Fehlings MG: Emerging repair, regeneration, and translational research advances for spinal cord injury. Spine 2010, 35(21 Suppl):S263-S270.
- [2]Van Den Berg MEL, Castellote JM, Mahillo-Fernandez I, De Pedro-Cuesta J: Incidence of spinal cord injury worldwide: a systematic review. Neuroepidemiology 2010, 34(3):184-192.
- [3]Norton L: Spinal Cord Injury, Australia 2007–2008. 52nd edition. Australian Institute of Health and Welfare Injury Research and Statistics series. Cat no. INJCAT 128, Canberra; 2010.
- [4]DeVivo MJ, Chen Y: Trends in new injuries, prevalent cases, and aging with spinal cord injury. Arch Phys Med Rehabil 2011, 92(3):332-338.
- [5]DeVivo M, Biering-Sorensen F, New P, Chen Y: Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal Cord 2011, 49(5):596-599. doi:510.1038/sc.2010.1172. Epub 2010 Dec 1037
- [6]Middleton JW, Dayton A, Walsh J, Rutkowski SB, Leong G, Duong S: Life expectancy after spinal cord injury: a 50-year study. Spinal Cord 2012, 50(11):803-811.
- [7]Middleton J, Lim K, Taylor L, Soden R, Rutkowski S: Patterns of morbidity and rehospitalisation following spinal cord injury. Spinal Cord 2004, 42:359-367.
- [8]Charlifue SW, Weitzenkamp DA, Whiteneck GG: Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being. Arch Phys Med Rehabil 1999, 80(11):1429.
- [9]Van Leeuwen CM PM, Westers P, Van Der Woude LH, De Groot S, Slusis T, Slootman H, Lindeman E: Relationships between activities, participation, personal factors, mental health, and life satisfaction in persons with spinal cord injury. Arch Phys Med Rehabil 2012, 93(1):82-89.
- [10]Middleton J, Tran Y, Craig A: Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Arch Phys Med Rehabil 2007, 88(12):1643-1648.
- [11]Lidal IB, Huynh TK, Biering-Sorensen F: Return to work following spinal cord injury: a review. Disabil Rehabil 2007, 29(17):1341-1375.
- [12]The Economic Cost of Spinal Cord Injury and Traumatic Brain Injury in Australia. Victorian Neurotrauma Initiative report, Melbourne; 2009.
- [13]Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L: The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 2005, 242(4):512-519.
- [14]MacKenzie E, Rivara F, Jurkovich G, Nathens A, Frey K, Egleston B, Salkever D, Scharfstein D: A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006, 354(4):366-378.
- [15]Early acute management in adults with spinal cord injury: a clinical practice guideline for healthcare professionals J Spinal Cord Med 2008, 31(4):403-479.
- [16]Fehlings M, Tator C: An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg 1999, 91(Supp 1):1-11.
- [17]Fehlings MG, Arvin B: The timing of surgery in patients with central spinal cord injury. J Neurosurg Spine 2009, 10(1):1-2.
- [18]Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B: Current practice in the timing of surgical intervention in spinal cord injury. Spine 2010, 35(21 Suppl):S166-S173.
- [19]Kwon B, Okon E, Hillyer J, Mann C, Baptiste D, Weaver L, Fehlings M, Tetzlaff W: A systematic review of non-invasive pharmacologic neuroprotective treatments for acute spinal cord injury. J Neurotrauma 2010, 27:1-44.
- [20]Donovan W, Carter R, Bedbrook G, Young J, Griffiths E: Incidence of medical complications in spinal cord injury: patients in specialised, compared with non-specialised centres. Paraplegia 1984, 22:282-290.
- [21]Heinemann A, Yarkony G, Roth E, Lovell L, Hamilton B, Ginsburg K, Brown J, Meyer PJ: Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs. general hospital short-term care. Arch Neurol 1989, 46:1098-1102.
- [22]DeVivo M, Kartus P, Stover S, Fine P: Benefits of early admission to an organised spinal cord injury care system. Paraplegia 1990, 28(9):545-555.
- [23]Tator C, Duncan E, Edmonds V, Lapczak L, Andrews D: Complications and costs of management of acute spinal cord injury. Paraplegia 1993, 31(11):700-714.
- [24]Tator C, Duncan E, Edmonds V, Lapczak L, Andrews D: Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia 1995, 33:254-262.
- [25]Dalyan M, Sherman A, Cardenas D: Factors associated with contractures in acute spinal cord injury. Spinal Cord 1998, 36:405-408.
- [26]Complications during the acute phase of traumatic spinal cord lesions Spinal Cord 2003, 41:629-635.
- [27]Amin A, Bernard J, Nadarajah R, Davies N, Gow F, Tucker S: Spinal injuries admitted to a specialised centre over a 5-year period: a study to evaluate delayed admission. Spinal Cord 2005, 43:434-437.
- [28]Middleton P, Davies S, Anand S, Marial O, Reinten-Reynolds T, Middleton J: The prehospital epidemiology and management of spinal cord injuries in NSW: 2004–2008. Injury 2012, 43:480-485.
- [29]Barr F: Preserving & Developing the National Spinal Cord Injury Service. Spinal Injuries Association report, London; 2009.
- [30]Ploumis A, Kolli S, Patrick M, Owens M, Beris A, Marino R: Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center. Spinal Cord 2011, 49(3):411-415.
- [31]Aito S: Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord 2002, 40:300-303.
- [32]Ahn H, Singh J, Nathens A, MacDonald R, Travers A, Tallon J, Fehlings M, Yee A: Prehospital care management of a potential spinal cord injured patient: a systematic review. J Neurotrauma 2011, 28:1341-1361.
- [33]Noonan VKSL, Atkins D, Lewis R, Santos A, Fehlings MG, Burns AS, Singh A, Dvorak MF: The application of operation research methodologies to the delivery of care model for traumatic spinal cord injury: the access to care and timing project. Neurotrauma 2012, 29:2272-2282.
- [34]Hoffman JR: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. (Abstract). JAMA 2000, 284(9):1070.
- [35]Burns S, Biering-Sørensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Kirshblum S, Mulcahey MJ, Read MS, Waring W: International standards for neurological classification of spinal cord injury, revised 2011. Top Spinal Cord Inj Rehabil 2012, 18(1):85-99.
- [36]Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL: Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale. J Spinal Cord Med 2007, 30(2):131.
- [37]Dodds TMD, Stolov W, Deyo R: A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 1993, 74:531-536.
- [38]Middleton JW, Truman G, Geraghty TJ: Neurological level effect on the discharge functional status of spinal cord injured persons after rehabilitation. Arch Phys Med Rehabil 1998, 79(11):1428-1432.
- [39]Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J: A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord 2007, 45(4):275-291.
- [40]Nichol AD, Higgins AM, Gabbe BJ, Murray LJ, Cooper DJ, Cameron PA: Measuring functional and quality of life outcomes following major head injury: common scales and checklists. Injury 2011, 42(3):281-287.
- [41]EuroQoL- a new facility for the measurement of health-related quality of life Health Policy 1990, 16:199-208.
- [42]Ware J Jr, Kosinski M, Keller SD: A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996, 34(3):220-233.
- [43]Lin MRHH, Chen CY, Chiu WT: Comparisons of the brief form of the World Health Organisations Quality of Life and Short Form - 36 for persons with spinal cord injuries. Phys Med Rehabil 2007, 86:104-113.
- [44]Lee BB, King T, Simpson JM, Haran MJ, Stockler MR, Marial O, Salkeld G: Validity, responsiveness, and minimum important difference for the SF-6D health utility scale in a spinal cord injured population. Value Health 2008, 11(4):680-688.
- [45]Widerstrom-Noga E, Biering-Sorensen F, Bryce TN, Cardenas DD, Finnerup NB, Jensen MP, Richards JS, Siddall PJ: The International Spinal Cord Injury Pain Basic Data Set (version 2.0). Spinal Cord 2014, 52(4):282-286.
- [46]Middleton JWTR, Geraghty TJ: Self-efficacy and spinal cord injury: psychometric properties of a new scale. Rehabil Psychol 2003, 48:281-288.
- [47]Post MW, de Witte LP, Reichrath E, Verdonschot MM, Wijlhuizen GJ, Perenboom RJ: Development and validation of IMPACT-S, an ICF-based questionnaire to measure activities and participation. J Rehabil Med 2008, 40(8):620-627.
- [48]von Elm EAD, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting obervational studies. BMJ 2007, 335:806-808.