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. 2017 Nov;40(6):676-686.
doi: 10.1080/10790268.2017.1368962. Epub 2017 Sep 12.

Predicting rehabilitation length of stay in Canada: It's not just about impairment

B Catharine Craven  1   2   3   4 , Dilnur Kurban  5 , Farnoosh Farahani  6 , Carly S Rivers  5 , Chester Ho  7   8 , A Gary Linassi  9   10 , Dany H Gagnon  11 , Colleen O'Connell  12 , Karen Ethans  13 , Laurent J Bouyer  14 , Vanessa K Noonan  5   15 ; RHSCIR Network
Affiliations

Predicting rehabilitation length of stay in Canada: It's not just about impairment

B Catharine Craven et al. J Spinal Cord Med. 2017 Nov.

Abstract

Introduction: Current tertiary Spinal Cord Injury (SCI) rehabilitation funding and rehabilitation length of stay (R-LOS) in most North American jurisdictions are linked to an individual's impairment. Our objectives were to: 1) describe the impact of relevant demographic, impairment and medical complexity variables at rehabilitation admission on R-LOS among adult Canadians with traumatic SCI; and 2) identify factors which extend R-LOS.

Methods: Data from 1,376 adults with traumatic SCI were obtained via chart abstraction and administrative data linkage from 15 Rick Hansen SCI Registry sites (2004-2014). Variables included age, sex, neurological impairment (level, severity), rehabilitation onset days, R-LOS, Glasgow Coma Score (GCS) at admission, prior ventilation or endotracheal tube (Vent/ETT), or indwelling bladder catheter at acute discharge, pain interference score, intensive care unit (ICU) length of stay (LOS), and lower extremity motor scores (LEMS) at rehabilitation admission. Variables related to R-LOS in bivariate analysis were included in multivariate analysis to determine their impact on R-LOS.

Results: Prior Vent/ETT tube, indwelling bladder catheter, GCS, LEMS, and neurological impairment were related to R-LOS in bivariate analysis. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001).

Conclusions: Based on the enclosed formula, and knowledge of an individual's age at injury, spinal cord impairment (level and severity), prior Vent/ETT, presence of an indwelling bladder catheter, and LEMS at admission, administrators and clinicians may readily identify patients for whom an extended R-LOS beyond conventional LOS targets is likely.

Keywords: Health system; Length of stay; Outcome measures; Rehabilitation; Spinal cord injury.

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Figures

Figure 1
Figure 1
R-LOS (days) for A) initially identified cohort (n=1455) and B) the cohort with outliers removed (n=1376) as used for analysis.
Figure 2
Figure 2
Box plot of R-LOS (days) among adults with traumatic SCI (2004–2014).
Figure 3
Figure 3
R-LOS (days) distribution based on the individual's neurological Level of injury and ASIA Impairment Scale category.
See this image and copyright information in PMC

References

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