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Outcomes of outpatient visits for acute respiratory illness in veterans with spinal cord injuries and disorders.
Weaver FM, Smith B, Evans CT, Kurichi JE, Patel N, Kapur VK, Burns SP. Outcomes of outpatient visits for acute respiratory illness in veterans with spinal cord injuries and disorders. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 2006 Sep 1; 85(9):718-26.
OBJECTIVE: Respiratory complications are a leading cause of death in persons with spinal cord injuries and disorders (SCIandD). We examined same-day and 60-day hospitalizations and 60-day mortality after acute respiratory illness (ARI) outpatient visits. DESIGN: A longitudinal study was conducted of 8775 ARI visits in the Veterans Health Administration (VA) (October. 1997-September 2002) by persons with SCIandD. ARIs included upper respiratory infections (URI), acute bronchitis, pneumonia, and influenza (PandI). RESULTS: URIs accounted for almost half of all (49%) visits. A total of 14.9% of patients with ARIs were hospitalized the same day; 30.8% were hospitalized within 60 days. Predictors of hospitalization included diagnosis of either PandI or acute bronchitis, comorbid illness, level of injury, age, and VA SCI center visit. Overall 60-day mortality was 2.9% but was 7.9% for pneumonia. Mortality was related to diagnosis (PandI: odds ratio [OR] = 9.80, 95% confidence interval [CI]: 6.27-13.33; acute bronchitis: OR = 2.00, 95% CI: 1.08-2.93), age (65+: OR = 3.96, 95% CI: 2.23-5.70), and comorbid conditions (OR = 1.94, 95% CI: 1.43-2.46). CONCLUSIONS: PandI and acute bronchitis were associated with increased VA hospitalization and mortality rates. The case fatality rate for pneumonia is higher for SCIandD than the general population. Level of injury predicted hospitalization but not death. Efforts to improve prevention and treatment of ARIs in persons with SCIandD are needed.