The pattern of urologic care among traumatic spinal cord injured patients.

Abstract

We assessed the urologic care patterns of traumatic spinal cord injury (TSCI) patients. This was a retrospective cohort study of adult TSCI patients injured between 2002 and 2012. The primary outcome was urologic consultation. The primary exposure was the year of injury. Measured covariates included lesion level, age, gender, comorbidity burden, and socioeconomic status. We identified 1551 incident TSCI patients who were discharged from a rehabilitation hospital in Ontario between 2002 and 2012. The median follow-up time of this cohort was 5.0 (inter-quartile range [IQR] 2.9-7.5) years. Within this cohort, 74% were male, and the mean age was 48 (IQR 33-63) years. In total, 66% of patients (1022/1551) were seen by a urologist in a median of 0.7 (IQR 0.2-3.0) years after the SCI. Over the study period, there was no change in the proportion of TSCI patients being assessed by a urologist within 1 year of their initial injury (median 55.1%, p = 0.92 for the trend). An adjusted Cox proportional hazards model demonstrated that TSCI patients who were female (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66-0.92) or over 65 years of age (HR 0.70, 95% CI 0.57-0.85) were significantly less likely to be referred to a urologist. Urologists are often not involved in the care of TSCI patients, and this has not changed significantly over the last 10 years. Females and older patients are significantly less likely to be referred to a urologist.