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B - What Does the E-Scan Tell Us

Across the 13 sites, 409 traumatic admissions, consisting of 128 at AIS A, 60 at AIS B, 88 at AIS C, and 130 at AIS D (Figure 3.0), were reported. Discharge data was incomplete, making discharge reporting impossible, in all cases. It is, however, important to examine a change in AIS scale (e.g., A to C), at a patient level. Understanding conversion scores is important, at the population level, which can be used to determine LOS, and inform program planning and resource allocation. Figure 3.0 Number of Patients Admited by ASIA Impairment Score (AIS) acros 13 Sites. 140 120 100 80 60 40 20 0 A B C D Number of Patients Admitted AIS Score As seen in Table 2.0, incomplete paraplegia and incomplete tetraplegia account for the highest proportion of individuals with SCI. Nontraumatic SCI accounts for the highest number of individuals admitted with incomplete paraplegia. In contrast, traumatic SCI accounts for most of the individuals admitted with complete paraplegia and both incomplete and complete tetraplegia. Included in the table are other admissions, with different etiologies, but these individuals present with similar impairments and symptoms to individuals with SCI, and require similar rehabilitation. Regardless of paraplegia or tetraplegia, incomplete injuries make provision of therapies more challenging, as therapeutic approaches need to be customized to the individual. Table 2.0 Number of Traumatic , Non-Traumatic and Total Admisions WITH Paraplegia and Tetraplegia (N=12) Table 3.0 shows the completeness of injury, including “unknown”, as reported by the sites. As an ASIA Impairment Score (AIS) is not consistently reported for non-traumatic SCI, and not used for other conditions, individuals with SCI are classified as AIS A (complete) or AIS B-D (incomplete). There are more individuals with incomplete injuries (B-D); this group is largely comprised of individuals with non-traumatic paraplegia. However, 70% of individuals are reported to have incomplete SCI. With differing neurological status at injury onset, these individuals require customized assessments because of major differences in the trajectory of neurological recovery and secondary health complications. Table 3.0 Number of Traumatic , Non-Traumatic and Total Admisions, by ASIA Impairment Score (AIS), for Tetraplegia and Paraplegia Tetraplegia Paraplegia AIS A B-D Unknown A B-D Unknown Trauma 51 148 8 63 60 7 Non-Trauma 7 95 10 30 137 20 Total 58 243 18 93 197 27 Table 4.0 Practice Pattern Differences acros Provinces (n = 12) Tetraplegia Paraplegia Province Non- Traumatic Traumatic Total/% Non- Traumatic Traumatic Total/% BC 4 20 24/7.5 10 17 27/6.5 Alberta* 11 16 27/8.5 18 11 29/7 Saskatchewan* 2 8 10/3.1 26 6 32/7.7 Manitoba – – –/– – – –/– Ontario* 41 67 108/33.9 160 65 225/54.4 Québec* 37 77 114/35.7 28 46 74/17.9 Nova Scotia 17 19 36/11.3 19 8 27/6.5 Total 112 207 319 261 153 414 Percentage of Total SCI 43.5 56.5 Admissions “–” INDICATES Data not provided. Interesting to note are the practice pattern differences, across the provinces (Table 4.0). Alberta*, Saskatchewan*, Ontario* and Québec* have a higher proportion of non-traumatic admissions, for those with paraplegia versus tetraplegia. For tetraplegia, it is quite striking that none of the facilities have comparable admission rates for the non-traumatic population. This raises questions as to the nature, or etiology, of injury for this population, with perhaps more oncology cases in the group with non-traumatic paraplegia. These differences need to be further investigated. For the 12 reporting sites, 62% of individuals with tetraplegia had injuries between C1-C4, with 27 (9%) of individuals sustaining a complete injury (*including two SCI patients admitted with ventilator dependency (Table 5.0)). Developing the necessary respiratory resources for the group, with complete high tetraplegia, is expensive and requires specific expertise. This suggests that some focused attention should be paid to the incidence, nationally, and on how programming is addressed, for this unique group. Neurological Level Traumatic Non-Traumatic Total Complete Paraplegia 63 30 93 Incomplete Paraplegia 60 137 197 Unspecified Paraplegia 7 20 27 Complete Tetraplegia 51 7 58 Incomplete Tetraplegia 148 95 243 Unspecified Tetraplegia 8 10 18 Total 337 299 636 40 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


B - What Does the E-Scan Tell Us
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