Rehabilitation Practices Table 11 Individual Studies – Early vs Delayed Admission (Acute Studies)

Author Year
Country
Research Design
Total Sample Size

Methods

Outcome

Daylan et al. 1998
USA
Case Control
Initial N=482;
Final N=482 

Population: 482 men and women with traumatic SCI admitted to a US Model Systems SCI Centre with specialized SCI acute care and rehabilitation services. Subjects included those with tetraplegia (256) & paraplegia (226) and AIS A, B, C (362) & D (120).
Treatment: No tx per se, comparison of those admitted 1. (< 24 hours post injury) vs 2. (> 24 hours – 60 days post-injury) to a specialized spinal acute care and rehabilitation unit.
Outcome Measures: Incidence of contractures during initial post-traumatic hospitalization.

  • Subjects who were admitted earlier (<24 hours) had significantly fewer contractures than those admitted later (>24 hours – 60 days) (p=0.05).
  • Other factors associated with an increased incidence of contractures included tetraplegia vs paraplegia (p<0.01), presence of a pressure ulcer (p=0.05), co-existence of head injury (p<0.05).

DeVivo et al. 1990
USA
Case Control
Initial N=661;
Final N=661

Population: 661 people with SCI admitted to a US Model Care System Centre with specialized SCI rehabilitation services. Subjects included those with tetraplegia and paraplegia and also those with incomplete vs complete injuries but frequencies were not provided. Average ages for early vs delayed admission groups were 29.5 and 32.0 years old respectively.
Treatment: No tx per se, comparison of those admitted earlier (< 24 hours post injury) vs later (> 24 hours) to a specialized integrated spinal unit (i.e., combined acute care and rehabilitation). Subjects were sub-grouped into i) paraplegia, incomplete, ii) paraplegia, complete, iii) tetraplegia, incomplete, iv) tetraplegia, complete.
Outcome Measures: Length of Stay (LOS), Hospital charges, Incidence of medical complications, Neurologic recovery, Mortality all collected at Discharge.

  • Those with complete paraplegia (p=0.0169) & incomplete tetraplegia (p=0.0001) admitted earlier (<24 hours) had significantly shorter total hospitalization LOS. A similar trend for those with incomplete paraplegia (p=0.0568), no difference for those with complete tetraplegia (p=0.928).
  • Mean hospital charges were less for subjects with complete (p=0.0099) and incomplete (p=0.0134) tetraplegia who were admitted earlier. Similar trend for those with incomplete paraplegia (p=0.0607), no difference for complete paraplegia (p=0.4777).
  • In general, no overall differences were seen in the development of medical complications between the early vs late admission groups. A few differences for incidence specific complications.
  • Trend for increased neurologic recovery with early admission in that 10/315 (3.2%) vs 4/401 (1.0%) in early vs late groups had complete recovery (p=0.08). Author warns of bias in this finding.
  • Mortality comparisons not possible within sample for early vs late admission groups. Comparison with historical data suggests enhanced survival rates with early admission.

Note: AIS=ASIA Impairment Scale; LOS=Length of Stay

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