Chest
Clinical InvestigationsMusculoskeletalImpact of Respiratory Complications on Length of Stay and Hospital Costs in Acute Cervical Spine Injury
Section snippets
Subjects
We retrospectively reviewed the database of the Midwest Regional Spinal Cord Injury Care System (MRSCICS) at Northwestern Memorial Hospital (NMH) for all patients with acute CSI admitted from 1993 through 1997. Since trauma to the chest can result in respiratory complications independent of the level of injury, patients with concurrent thoracic injuries were excluded.
Subjects with either motor or sensory neurologic deficits were classified at the highest level of bilateral normal function
Distribution of Neurologic Injury
The distribution of ASIA classification level as a function of neurologic level of injury is presented in Figure 1. Among those with a motor level of injury, complete injuries (ASIA impairment classification A) were present in 79 subjects (44%) and incomplete injuries (ASIA classifications B, C, and D) were found in 92 subjects (51%).13 The ASIA classification was unknown in nine subjects (5%). The distribution of motor levels of injury and ASIA classifications for this cohort did not differ
Discussion
This study demonstrates that the occurrence of respiratory complications in patients with acute CSI contributes significantly to both LOS and hospital costs for the initial acute-care hospital admission. Our analysis shows that four variables—use of mechanical ventilation, occurrence of pneumonia, the need for surgery, and use of tracheostomy—explain nearly 60% of the variance in hospital costs for this cohort. Further, each of these variables, when considered independently, is a better
ACKNOWLEDGMENT
The authors thank David Kamp, MD, and Jacob I. Sznajder, MD for their review of this article.
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This project was partially funded by the Department of Education, National Institute on Disability and Rehabilitation Research, No. H133N50002.