Page 5

T - New Perspectives From E-Scan

The consequences of NTSCI are equally catastrophic to those with TSCI. Individuals with NTSCI require a similar, parallel and integrated system of care, with linked resources across the continuum of prehospital, acute, rehabilitation and outpatient service delivery. A Cross-Continuum System of Care for NTSCI is Needed FIGURE 3.0. THE AGE PROFILE OF THE 2010 CANADIAN POPULATION, BIMODAL DISTRIBUTION OF TScI AND NTSCI, AND THE RISING INCIDENCE OF NTSCI. Reproduced from Noonan V, Fingas M, Far y A, et al. Incidence and prevalence of spinal cord injury in Canada : a national perspective. Neuroepidemiolog y. 2012;38 :219-26. © 2012 S. Karger AG Basel. Reprinted with permision. 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 Age Profile of 2010 Canadian Population TSCI NTSCI The strategy, for individuals with NTSCI, must be predicated on the principle of prevention to eliminate current high rates of misdiagnosis, late pickup of disease (once motor symptoms are present), long waiting lists for appropriate medical and surgical intervention, and self-referrals to rehabilitation settings with insufficient expertise to appropriately manage these individuals and their impairments. Rather, care must be customized for the individual’s presenting impairment, the underlying disease or pathology, and their co-morbid medical conditions. The system of care must be tailored to minimize injury, preserve function, maximize recovery and facilitate community integration. From National Reporting System (NRS) data, it is evident that a high proportion of individuals with NTSCI, are receiving inpatient rehabilitation, outside of tertiary academic sites, potentially compromising their access to the appropriate timing and intensity of rehabilitation services. The reasons for the observed referral patterns were not self-evident but may relate to having initial surgical/medical intervention outside of a tertiary spine centre, medical co-morbidity, proximity to family or tertiary SCI rehabilitation admission criteria and intake processes. In an ideal model of NTSCI care, there should be opportunities for pre-hab – interprofessional assessment and monitoring of individuals, prior to or at the time of initial onset of motor or autonomic deficits, prior to surgical intervention. 0..4 6,000 5,000 4,000 3,000 2,000 1,000 Annual cases 5..9 10..14 15..19 20..24 25..29 30..34 35..39 40..44 45..49 50..54 55..59 60..64 65..69 70..74 Age Surveillance for Non-traumatic SCI (NTSCI) Population 75..79 80..84 85..89 90+ 0 Individuals with NTSCI now comprise 50% or more of those admitted for inpatient rehabilitation (Figure 3.0). Current SCI surveillance strategies in Canada (RHSCIR, NTR, NRS) have limited ability to identify or track the incidence, prevalence, resource requirements and outcomes of persons with NTSCI prior to admission to rehabilitation. A substantial portion of this challenge is attributable to difficulties with case finding, due to a lack of consensus regarding how to best use current ICD-10 codes, to identify individuals with NTSCI. Resolution of these coding controversies, and addition of NTSCI data fields, service interruptions, and relevant measures of medical co-morbidity to RHSCIR would substantially enhance our understanding of the incidence, prevalence, and rehabilitation resource utilization, as well as future resource requirements, of this population. For individuals with traumatic SCI, an established system of care recognizes: • The value of appropriate prehospital care • Timely referral to a Level I trauma/spine centre • Early decompression (where appropriate) by a skilled spine surgeon, recognizing the principle of “Time to Spine” • Early admission to tertiary rehabilitation, to access interprofessional expertise and optimize neurological and functional outcomes, with minimization of the frequency and severity of secondary health complications • Lifetime surveillance and management of related health conditions, by healthcare professionals, with appropriate expertise. 202 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


T - New Perspectives From E-Scan
To see the actual publication please follow the link above