A multicenter investigation of age-related differences in lengths of stay,hospitalization charges, and outcomes for a matched tetraplegia sample

Objective: To examine the effects of age at injury on lengths of stay, trea tment costs, and outcomes using a matched sample of tetraplegic spinal cord injury (SCI) patients. Design: Differences were examined by separating the sample into three age c ategories (18 to 34, 35 to 64, and 65 + years old) matched for American Spi nal Injury Association (ASIA) Motor Impairment Classification and level of neurologic preservation bilaterally. Analysis of variance was used to exami ne age group differences for lengths of stay, medical expenses, and functio nal outcome. Setting: Sixteen medical centers in the federally sponsored Spinal Cord Inj ury Model Systems Project. Participants: Three hundred seventy-five adult patients with tetraplegic SC I admitted between 1988 and 1996 were assessed at acute care admission, inp atient rehabilitation admission, and inpatient rehabilitation discharge. Main Outcome Measures: ASIA Motor Index and Functional Independence Measure (FIM) admission, discharge, and efficiency scores; acute care and rehabili tation lengths of stay and medical care charges; and discharge disposition. Results: Analyses revealed equivalent lengths of stay and charges for all a ge groups. There were no age-related differences in ASIA and FIM Motor scor es at acute care and inpatient rehabilitation admission. Younger patients' scores on the FIM Motor subscale improved significantly more than did middl e and older patients'. The two younger groups of patients had a more signif icant improvement than did older patients, as indicated by ASIA Motor Index scores. When taking lengths of stay into account, the FIM motor scores of the youngest group of patients improved more quickly than those of the two older groups. Furthermore, the younger and middle age groups demonstrated g reater treatment efficiency than the older patient group based on ASIA Moto r Index score ratios. Younger patients were least likely to be discharged t o institutional settings. Conclusions: Along with neurologic and functional status, age should be con sidered when formulating treatment plans and prognostic statements. For old er patients, alternative rehabilitation settings with lower-intensity treat ment and lower charges may prove to be a more efficacious use of resources. (C) 1999 by the American Congress of Rehabilitation Medicine and the Ameri can Academy of Physical Medicine and Rehabilitation.