Citation

Chu D, Lee YH, Lin CH, Chou P, Yang NP. BMC Health Serv. Res. 2009; 9(1): 137.

Copyright

(Copyright © 2009, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/1472-6963-9-137

PMID

19650923

PMCID

PMC2729309

Abstract

BACKGROUND: The aim of this study was to investigate the prevalence of concomitant injuries among hospitalized acute spinal trauma patients aged 20 and over and the effects of those injuries on medical utilization in Taiwan. METHODS: Nationwide inpatient datasets of Taiwan's National Health Insurance (NHI) database from between 2000 and 2003 were used. The major inclusion criteria used to select cases admitted due to acute spinal trauma were based on diagnostic codes, which needed to be classified as one of three International Classification of Disease, 9th Version (ICD-9) codes items: (1) 805.X (fracture of vertebral column without mention of spinal cord injury); (2) 806.X (fracture of vertebral column with spinal cord injury); or (3) 952.X (spinal cord lesion without evidence of spinal bone injury). To investigate the associated injuries among the eligible subjects, the concomitant ICD-9 diagnosis codes were evaluated and classified into six co-injury categories: (1) head trauma, defined as coded 800-804 (fracture of skull) or 850-854 (intracranial injury, excluding those with skull fracture); (2) chest trauma, coded 807 (fracture of ribs, sternum, larynx and trachea), 860 (traumatic pneumothorax and hemothorax), 861 (injury to heart and lung), or 862 (injury to other and unspecified intra-thoracic organs); (3) abdominal trauma, coded 863 (injury to gastrointestinal tract), 864 (injury to liver), 865 (injury to spleen), 866 (injury to kidney), or 868 (injury to other intra-abdominal organs); (4) pelvic trauma, coded 808 (fracture of pelvis) or 867 (injury to pelvic organs); (5) upper extremities trauma, coded 810-819 (fracture of upper limb); (6) lower extremities trauma, coded 820-829 (fracture of lower limb). RESULTS: There were 51,641 cases enrolled. In general, hospitalized acute spinal trauma subjects stayed in hospital for 8.5+/-8.8 days and incurred a cost of $1,360+/-2,520 during 2000-2003 in Taiwan; 27.6% of the enrolled subjects suffered from neurological deficit, but only 17.3% underwent a surgical procedure for spinal injury. Among the cases studied, the prevalence of associated injuries were as follows: head trauma, 17.2%; chest injury, 2.9%; abdominal trauma, 1.5%; pelvic injury or fracture, 2.5%; upper limb fracture, 4.4%; lower limb fracture, 5.9%. The three major locations of acute spinal injury (cervical, thoracic, or lumbar spine) were found to be combined with unequal distributions of associated injuries. By stepwise multiple linear regression, gender, age, location of spinal injury, neurological deficit, surgical intervention and the six combined injuries were identified significantly as associated factors of the two kinds of medical utilization, length of stay (LOS) and direct medical cost. The combinations of acute spinal trauma with lower extremity injury, pelvic injury, chest injury, abdominal injury and upper extremity injury resulted in of the highest utilization of medical resources, the estimated additional LOS being 4.3, 3.6, 3.5, 2.4 and 1.2 days, respectively, and the extra medical cost calculated as being between $1,230 and $320. CONCLUSIONS: The occurrence of associated injuries among hospitalized acute spinal trauma patients in Taiwan is not uncommon, and results in an obvious effect on medical utilization.

Language: en