The Real Predictors of Disposition in Patients with Spinal Cord Injuries

Abstract

A primary goal of health care providers for managing patients with spinal cord injury (SCI) is to discharge them to a rehabilitation facility (RF) to allow for maximal functional recovery. This study was undertaken to analyze hospital mortality and disposition of patients with SCI with a specific focus on evaluating the effect of payor source on discharge to a RF. Our hypothesis was that commercial insurance (CI) would be the greatest influence of hospital disposition. All patients under 60 years of age with SCI over a 7-year period were identified from the trauma registry; and grouped according to payor source: No insurance (NI), Government insurance (GI), No Commercial insurance (NCI) (NCI = NI + GI), and CI. A total of 492 patients with SCI were identified with a mean age of 33, an ISS of 29, and a hospital mortality of 7.7%. Independent predictors of mortality were cervical SCI and blood transfusions. Patients who were discharged to a RF had higher ISS and %CI with lower functional independent measurement scores compared with patients who were not discharged to a RF. Logistic regression analysis demonstrated that the predictors of disposition to a RF were CI (p < 0.001) and ISS (p = 0.002). The presence of CI was an independent predictor of disposition to a RF for patients with SCI. Lack of commercial insurance clearly compromises recovery and rehabilitation of patients with SCI and predicts outcome more clearly than any other parameter. Additional funding for patients without CI is necessary to afford all with an equal opportunity for maximal functional recovery.