NEUROLOGICAL RECOVERY, MORTALITY AND LENGTH OF STAY AFTER ACUTE SPINAL-CORD INJURY ASSOCIATED WITH CHANGES IN MANAGEMENT

Based on epidemiological data from two populations of patients with ac ute spinal cord injury (ASCI), three outcome measures were compared to evaluate the effectiveness of management of ASCI patients in a region al, specialized acute spinal cord injury unit (ASCIU). The two populat ions consisted of a pre-ASCIU group of 351 patients managed from 1947- 73 before the establishment of the ASCIU, and an ASCIU group of 201 pa tients managed in an ASCIU from 1974-81. The three outcome measures we re mortality rate, length of stay (LOS) during first hospitalization, and neurological recovery. Linear regression and multiple regression a nalyses were used to determine whether differences in the outcome meas ures were attributable to differences in admission variables in additi on to the influence of the ASCIU. The results showed that the patients treated in the ASCIU had a significant reduction in the mortality rat e of almost 50% (P = 0.022), a significant reduction in the LOS of alm ost 50% (P<0.001), and a significant increase in neurological recovery consisting of a doubling of the neurological recovery scale utilized (P<0.001). Multiple regression analysis showed that the reduction in m ortality rate was significantly influenced by differences in the admis sion variables between the two groups. However, the establishment of t he ASCIU was associated with a significant reduction in LOS and a sign ificant improvement in neurological recovery. Thus, these results supp ort the view that management of ASCI patients in a regional, multidisc iplinary unit is medically advantageous and can reduce the LOS.