Risk and protective factors for emergency department visits and related hospitalizations among ambulatory adults with traumatic spinal cord injury.

OBJECTIVE

To identify the risk and protective factors for emergency department visits (EDV) and inpatient admissions through the ED (EDIP) among a population-based cohort of ambulatory adults with spinal cord injury (SCI).

DESIGN

Prospective self-report cohort study linked to administrative billing data.

SETTING

A Medical University in the Southeastern USA.

PARTICIPANTS

656 ambulatory adults (>18 years old) with chronic (>1-year), traumatic SCI identified through a statewide population-based registry.

OUTCOME MEASURES: EDV and EDIP in non-federal state hospitals in the year following self-report.

RESULTS

In the final model, lower rates of future EDV were associated with being older (incidence rate ratio, IRR = 0.99), greater time since injury (IRR = 0.94), and higher income (IRR = 0.89). The EDV rate among non-white individuals was 1.49 times as high as white individuals (P = 0.01). Higher rates of future EDV were associated with using prescription medications for pain, spasticity, sleep, and stress (IRR = 1.30), having depression (IRR = 1.16) and a greater number of chronic conditions (IRR = 1.13), and more past year urinary tract infections (IRR = 1.32), upper extremity broken bones (IRR = 1.37), and serious injuries (IRR = 1.20). Factors associated with higher rates of future EDIP included urban location (IRR = 2.07), higher levels of education (IRR = 1.85), and having a current pressure injury (IRR = 2.94). Married or coupled individuals (IRR = 0.48), and those who reported more days per month of inadequate sleep had lower rates of EDIP (IRR = 0.96).

CONCLUSIONS

Several preventable health related factors were significantly related to EDV. The study findings may help clinicians predict and prevent EDV, empower stakeholders for better self-management of their health, and inform decisions to promote the reduction of costly EDV and EDIP.