The Disease Burden And Outcome Of Hospitalized Patients With Traumatic Spinal Cord Injury In China

BackgroundTraumatic spinal cord injury(TSCI)is an acute neurological injury disease caused by traumatic incidents.It has the characteristics of suddenness,high disability,high treatment cost,long recovery time and poor prognosis.It will not only cause serious harm to the individual’s physical and mental,but also have a huge economic burden to the entire family and society.TSCI is a preventable traumatic disease.Effective disease characteristic data are needed to support the development of preventive strategies.On the global scale,there were few studies about the TSCI epidemiology and the cost of treatment.Only a few high-income countries and regions have established a trauma registration system to obtain real-time data on the epidemiological characteristics of TSCI,while a population-wide epidemiological survey of TSCI hasn’t been carried out in China.From the perspective of the treatment system and mode of treatment for injuries in China,TSCI patients tend to flow to the tertiary hospital inpatient medical record system after onset.Therefore,through the development of the epidemiological survey of Chinese TSCI inpatients based on the tertiary hospital medical record system and other related research,it is possible to initially understand the hazard extent and characteristics of TSCI to Chinese population,and provide a basis for formulating TSCI prevention and treatment strategies.ObjectiveAccording to the epidemiological survey of TSCI inpatients in China and the cost survey of TSCI inpatients in Xi’an Honghui Hospital,describe the epidemiological characteristics of TSCI inpatients,analyze the factors that affect the cost and outcome of TSCI inpatients,and get a preliminary understanding of the disease burden and outcome of TSCI inpatients in China.MethodsFirstly,Through the epidemiological survey of TSCI inpatients in china,the epidemic characteristics of TSCI were analyzed.This survey used the multi-stage stratified cluster sampling method to collect information on the population,injury,and treatment characteristics of TSCI inpatients which was admitted from 31 provinces,municipalities,and autonomous regions in China.4404 inpatients were included after data cleaning.The number of TSCI inpatients in tertiary hospitals in China was estimated based on complex sampling weighting and the proportion of beds related to spinal cord injury,and then described the characteristic distribution of inpatients.Secondly,through the investigation of TSCI inpatient costs in Xi’an Red Cross Hospital,the situation of TSCI inpatient costs was analyzed.Collect the data of TSCI inpatients admitted from August 1,2019 to July 31,2020 from the medical records system of Xi’an Red Cross Hospital,a total of 382 inpatients.Based on the above data,the distribution of hospitalization cost with different characteristics was described,and the multiple linear regression model was used to analyze the factors that affected hospitalization cost.Finally,the changes in the ASIA injury classification of admission and discharge in the epidemiological survey data of TSCI inpatients in China were used to describe the current status of the neurological outcome of TSCI inpatients in China,and the two-level logistic random intercept regression model was used to analyze the factors affecting the neurological outcome of inpatients in different hospitals.ResultsAccording to the data from the epidemiological survey of TSCI inpatients in China,the number of TSCI inpatients in tertiary hospitals in China in 2018 was approximately 72 907.The incidence rate of hospitalized patients was 52.35/1 million.In the demographic distribution of 4404 TSCI inpatients,the average age was 51.6 years old,and the proportion of patients ≥60 years old was 32.4%.The male to female ratio was 3:1,and the male to female ratio between 0-9 years old was the lowest(2:5),30 to 39 years old was the highest(4:1).The proportion of farmers and workers was the highest(56.2%).Among the causes of injury,high falling was the primary cause of TSCI inpatients(30.1%),which was common in men and young adults,and falls was the secondary cause(28.2%),which were common in women,children and the elderly.In the level and degree of injury,cervical spinal cord injury was the highest,of which incomplete spinal cord injury accounts foe 86.0%.Compared with cervical spinal cord injury,the average age of thoracic spinal cord injury was lower,and the proportion of complete spinal cord injury was high(48.4%).In the admission ASIA injury classification,grade D spinal cord injury was the largest.There were statistically significant differences in hospital admission ASIA injuries of genders and ages.Among that,the proportion of males with grade A to C spinal cord injuries was higher than that of females,and The proportion of grade B spinal cord injury in the group under 10 years old was the highest,while the other age groups were grade D.The main cause of inpatients with grade A and B spinal cord injuries admitted to the hospital were high falling,and those with grade C and D injuries were falls.In the distribution of treatment characteristics,the median length of hospital stay was 14 days,the proportion of patients admitted within 2 hours after injury was 7.5%,and those who had surgery on the day of injury accounted for 1.9%.The proportions of patients who received surgery and rehabilitation were 71.8%and 37.4%,respectively.Based on the TSCI hospitalization cost survey data of Xi’an Honghui Hospital,the total cost of 382 TSCI inpatients was 39.08 million yuan,the mean hospitalization cost was 10,2305.2 yuan,the median hospitalization cost was 76569.4 yuan,the average hospitalization cost per time was 43959.5 yuan.In the analysis of the influencing factors of TSCI hospitalization costs,the length of hospital stays had the greatest impact on hospitalization costs,followed by surgery grade,combined injury,causes of injury,rehabilitation treatment,and admission ASIA injury classification.Based on the data from the epidemiological survey of TSCI inpatients in China,the neurological improvement proportion of 4404 TSCI inpatients was 27.3%.In the distribution of discharged ASIA injury classification,grade D spinal cord injury was the highest,followed by grade C,A,E,and B.The proportion of grade D spinal cord injury in different age groups was the highest,and its proportion raised with age.In the analysis of the influencing factors of the outcome of TSCI,the difference in the outcome of spinal cord injury in different hospitals was statistically significant,and the intra-class correlation coefficient(ICC)was 24.2%.At the inpatient level,age,the level and extent of injury,and accompanying fractures or dislocations were negatively correlated with spinal nerve outcomes,while the time from injury to operation,surgical intervention and rehabilitation were positively correlated with it.ConclusionBased on the epidemiological survey of TSCI inpatients in China and the cost survey of TSCI inpatients in Xi’an Honghui Hospital,the following conclusions were drawn:(1)This study estimated that there were about 72907 TSCI inpatients in tertiary hospitals in China in 2018.In the absence of population-wide TSCI epidemiological survey data,this data has certain reference value for elucidating the current status of TSCI disease burden in China.(2)The hospitalization cast of TSCI patients(median hospitalization cost is 76569.4 yuan)was higher than the per capital disposable income of the same period,suggesting that the direct economic burden of TSCI patients in China was heavier.Multivariate analysis showed that hospitalization costs were affected by factors such as length of stay,surgical grade,admission ASIA,combined injury,injury etiology,and rehabilitation treatment.(3)The outcome of TSCI inpatients was poor,suggesting that after the patients were discharged from the hospital,they will bring a long-term disease burden to individuals,families,and society.Multivariate analysis showed that the outcome was affected by factors such as age,injury level and degree,accompanying fracture or dislocation,time from injury to surgery,surgery and rehabilitation.(4)Main characteristics of TSCI inpatients:TSCI was common in middle-aged and elderly people,and male migrant workers were high-risk groups.High Falling was the primary cause of TSCI inpatients.Different genders and ages had different causes of TSCI.High falling and traffic accidents were more common in male young adults,while falls were more common in women,children and the elderly.Most inpatients with TSCI had neck injuries,and the proportion of complete injuries was relatively low.Men and young adults have severe injuries.