Hospital readmissions in people with chronic spinal cord injury

Study design: Longitudinal observational. Objectives: To examine frequency and duration of hospital readmissions in a population based sample of people with chronic spinal cord injury (SCI) and to look at medical reasons necessitating readmissions and factors influencing them. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK and Regional Spinal Injuries Centre, District General Hospital, Southport, UK. Methods: One-hundred-and-ninety-eight SCI patients, all injured more than 20 years ago, were interviewed on three occasions and their medical records reviewed for the period 1990-1996. Results: Between 1990 and 1996, 127 patients (64% of the sample) required hospital treatment for late medical complications, with 481 readmissions between them and the mean length of stay of 12.03 days per readmission. Only 58% of all readmissions were into specialised spinal injuries centres. Averaged over the entire sample, the readmission rate was 0.4 readmissions per person at risk per year, and the occupancy rate was 4.9 bed-days per person at risk per year. The most frequent reason for readmissions were urinary tract complications (40.5% of all readmissions) and the highest bed occupancy was for skin problems (32.2% of all bed-days). When compared with the non-hospitalised group (36% of the sample), the readmitted patients had longer duration of paralysis and lower disability and handicap scores as measured by Functional Independence Measure (FIM) and Craig Handicap Assessment & Reporting Technique (CHART). The subgroups did not differ significantly by neurological grouping or age. Conclusions: Urinary and skin complications are the two main reasons for hospital readmissions in people with chronic SCI. Risk of readmissions increases with time since injury and with disability and handicap severity. Hospital bed requirements for people with chronic SCI are greater than the amount of clinical provision currently available in specialised spinal centres. In order to meet the needs of the growing SCI population, more specialised spinal injuries care beds will be needed.