Medical complications during acute rehabilitation following spinal cord injury - Current experience of the model systems

Objectives: To examine the frequency of common secondary medical complicati ons during acute rehabilitation in persons with new spinal cord injury (SCI ). Design: Survey and analysis of data in the National SCI Statistical Center (NSCISC) database. Setting: Eighteen Model System SCI Centers located in urban, public medical centers around the United States. Subjects: A total of 1,649 persons with new SCI entered into the NSCISC dat abase between 1996 and mid-1998. Results: Since 1992, the number of days from injury to admission to rehabil itation has steadily decreased, resulting in the increased potential to dev elop common secondary medical complications during rehabilitation hospitali zation. Pressure ulcers occur with high frequency and were found to have de veloped in 23.7% of patients during rehabilitation. In addition, autonomic dysreflexia and atelectasis/pneumonia also occur with relative frequency du ring rehabilitation. Conversely, deep vein thrombosis and pulmonary embolis m have decreased, most likely because of greater awareness of their potenti al to develop, as well as improved methods of prophylaxis. Cardiopulmonary arrest and gastrointestinal hemorrhage occur with relatively small frequenc y. The frequency of renal complications is difficult to gauge because of th e decreasing number of patients who have any renal testing performed during rehabilitation hospitalization. Conclusion: The continued declining lengths of acute care hospitalization a fter SCI have resulted in the occurrence in the rehabilitation setting of m edical complications that were previously seen in acute care. Greater aware ness and attention to these conditions are necessary to reduce their occurr ence, so that obstacles to recovery and functional improvement after SCI ar e minimized. (C) 1999 by the American Congress of Rehabilitation Medicine a nd the American Academy of Physical Medicine and Rehabilitation.