1. Processes and outcomes of acute care: towards strengthening health systems for acute survivors of traumatic spinal cord injury in South Africa
Conran Joseph1,2, Åke Seiger 1, Lena Nilsson Wikmar 1, Julie Phillips2 , Claes Hultling1,3 , Kerstin Wahman1,3
1Karolinska Institutet, Stockholm, Sweden; 2University of the Western Cape, Cape Town, South Africa; 3Rehab Station Stockholm/Spinalis R&D Unit, Stockholm, Sweden
Processes of care comparison
Conclusions
Processes and outcomes differ between contexts, with a higher mortality rate and occurrence of pressure ulcers found in South Africa.
Despite the lack of causal inference, evidence from this prospective cohort study could be used for the promotion of systems of care in South Africa.
Cape Town
Stockholm
p value
Processes
Intermediate hospitalisations
34/145
2/45
0.01
Vertebral injuries
Spinal surgery
Time to surgery
<48hrs
≥48hrs
106/145
71% 18 56
43/45
100% 32 11
<0.001
Acute hospital stay
Mean (±s.d.)
Median (min-max)
36.5 (36.8)
24 (3-245)
44.4 (25)
42 (3-131)
Results
Participant characteristics
Introduction
A systems approach towards the management of spinal cord injuries (SCI’s) had been advocated for; however its adoption is rather slow in developing contexts.
Cape Town
(RSA)
Stockholm
(Sweden)
P value
Gender
Male
Female
124 (85.5)
21 (14.5)
27 (60)
18 (40)
< 0.001
Age at injury
Median (range)
29 (18-93)
58 (69; 18-85)
 <0.001
Aetiology (n; %)
Sport
Assault
Transport
Falls
‘Other trauma’
1 (0.7)
86 (59.3)
38 (26.3)
17 (11.7)
3 (2.0)
1 (2)
0 (0)
26 (58)
<0.001
Neurological category
Ventilation dependent
C1-C4 AIS A, B, C
C5-C8 AIS A,B, C
T1-S5 AIS A, B, C
All AIS D
28 (19.3)
23 (15.9)
41 (28.3)
53 (36.5)
9 (20)
2 (5)
10 (22)
24 (53)
0.09
Purpose
To provide an evidence-based foundation for strengthening health systems by investigating selected processes affecting outcomes in two international contexts – Sweden following a systems, and South Africa a general (non-systems), approach.
Method
Population-based cohort study of all injured, within a one-year period in two international contexts.
Process of care and outcome variables were prospectively evaluted.
Conran Joseph (PhD)
Department of Neurobiology, Care Sciences and Society
Division of Physiotherapy
Telephone: