Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study

Study Design: Retrospective cohort design. Objectives: To compare socio-demographic, impairment characteristics and utilization (physician and emergency department (ED) visits) for non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury 1 year post inpatient rehabilitation. Setting: Ontario, Canada. Methods: Inpatient stays (2003-2006) were identified from the National Rehabilitation Registry System. Exclusions were: in-hospital mortality; discharge after 31 March 2006; death within 1 year after discharge. Multivariate logistic regression analyses were used to determine factors predicting high utilization. Results: NTSCI cases (n = 1002) were greater than TSCI (n = 560). NTSCIs were older (mean = 61.6, s.d. = 15.8) with more co-morbidities, paraplegic (39.5%) and female (P < 0.001). NTSCI had higher FIM admission and discharge scores but lower change scores. Mean number of physician visits for NTSCI and TSCI were 31.2 (median = 24) and 29.7 (median = 22), with no significant differences in mean specialist visits (NTSCI 16.5: TSCI 17.0). Factors predicting 30 or more physician visits included age 60 years or above (OR = 1.5; 95% CI = 1.2-1.9), urban living (OR = 1.59; 95% CI = 1.12-2.22) and lowest quartile (18-88) discharge FIM (OR = 1.8; 95% CI = 1.4-2.3). Charlson score of 3 or more (OR = 2.1; 95% CI = 1.3-3.2), urban living (OR = 1.92; 95% CI = 1.3-2.86) and lowest quartile discharge FIM (OR = 1.5; 95% CI = 1.2-2.0) were associated with 20 or more specialist visits. Factors for high ED use were: rurality (OR = 1.5; 95% CI = 1.1-2.1), low income (OR = 1.4; 95% CI = 1.1-1.9) and low (18-88) discharge FIM (OR = 1.7; 95% CI = 1.3-2.2). Conclusion: Both demonstrated significant health care utilization requiring attention to health care needs; particularly for those living in rural settings, with low income and/or low functional ability. Spinal Cord (2010) 48, 45-50; doi:10.1038/sc.2009.78; published online 23 June 2009