Characteristics of Non-traumatic Spinal Cord Dysfunction in Canada Using Administrative Health Data

Top Spinal Cord Inj Rehabil, 2017 · DOI: 10.1310/sci2304-343 · Published: January 1, 2017

Spinal Cord Injury Healthcare Public Health

Simple Explanation

This study uses Canadian health administrative data to understand non-traumatic spinal cord dysfunction (NTSCD). It aims to characterize different groups of NTSCD patients using specific criteria and algorithms. The researchers analyzed hospital, emergency department, and rehabilitation records from 2004 to 2011 to identify and classify NTSCD cases into three groups: most likely, probable, and possible. The study found that the "most likely" NTSCD group was older, had more women, and a higher proportion of cauda equina lesions compared to the other groups. Factors like age, sex, location (urban vs. rural), and having an MRI were linked to inpatient rehabilitation admission.

Study Duration

April 1, 2004 to March 31, 2011

Participants

Patients 18 years and older with paraplegia, tetraplegia, or cauda equina syndrome (n = 20,318)

Evidence Level

Not specified

Key Findings

1
The most likely NTSCD group (n = 6,362) was significantly older and had a greater proportion of women and individuals with cauda equina lesions compared to the other 2 NTSCD groups.
2
Factors associated with the likelihood of an inpatient rehabilitation admission included being older, being female, having a paraplegia diagnosis compared to cauda equina, residing in an urban area compared to a rural area, having degenerative etiology, and having an MRI on record.
3
Individuals in the most likely NTSCD group were slightly older, had a greater proportion of females, were more likely to have a MRI on record during the acute admission, and had diagnoses of cauda equina with fewer diagnoses of tetraplegia.

Research Summary

This Canadian study used national administrative health data to identify and characterize NTSCD patients, using decision algorithms to classify them into three groups. The study found variations in characteristics among the groups, with the "most likely" NTSCD group being older and having a different gender distribution and lesion type. The research highlights the importance of validating administrative data methodology and suggests that a broader approach is needed to capture an accurate description of NTSCD, going beyond data solely from rehabilitation facilities.

Practical Implications

Improved Case Identification

The study contributes to improved methodologies for identifying NTSCD cases using administrative health data, which can assist with public education, prevention, and resource planning.

Informed Policy and System Planning

Advancing our knowledge of NTSCD epidemiology, health outcomes, and system performance can inform policy and system planning.

Ongoing Surveillance

Administrative data allow for ongoing surveillance of a population in a relatively cost-effective manner, especially for lower prevalence conditions such as NTSCD.

Study Limitations

1
The algorithm required patients to be hospitalized in the acute setting; if a person had an NTSCD but was not hospitalized within our observation window, then this person would not be captured with the administrative health data.
2
We did not have an extensive look back period to wash out any chronic NTSCD cases for a true incidence study.
3
Temporal variations of symptom presentation may range from minutes (eg, cord infarction) to hours (eg, transverse myelitis), days (eg, spinal abscess), or up to months (eg, spinal canal stenosis).

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