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Implications of Polypharmacy to Clinical Practice for Traumatic Spinal Cord Injury: A Population-Based Approach in British Columbia, Canada
DOI: https://doi.org/10.1177/2689288X261452216
Introduction
Traumatic spinal cord injury (TSCI) is a life-changing event that can leave patients with permanent motor, sensory, and autonomic dysfunction. TSCIs affect patients, their families, and caregivers and have significant implications for health care systems, including increased costs and utilization of health care services. It has been shown that TSCI is most likely to occur among young adult males involved in motor vehicle collisions (MVCs), though rising rates of TSCI have been recently reported among the elderly population suffering low-energy falls.
Materials and Methods
This study was based on a retrospective analysis of a population-based cohort of patients with TSCI whose injuries occurred between January 2001 and December 2022. This population-based study took place in BC, which is a province in Canada that has over 5 million residents and represents about 13% of the Canadian population. Cohort members were identified through population-based analyses of linked population-level administrative datasets. This study utilized linked hospital discharge records, physician billing data, and provincial demographic statistics information. For this study, TSCI patients were linked across several sources of data through Population Data BC, including the hospital discharge summaries in the Discharge Abstract Database (DAD), BC’s Vital Events and Statistics—Deaths, Medical Services Plan (MSP), PharmaNet, WorkSafeBC, the BC Trauma Registry, and the Rick Hansen Spinal Cord Injury Registry (RHSCIR). The protocol for linkage has been described elsewhere.TSCI cohort members were identified using International Classification of Diseases (ICD) 10-CA codes in the DAD (See Supplementary Appendix). The codes were validated elsewhere and included all levels and severity of TSCI, including cervical, thoracic, lumbar, complete/incomplete injuries, and cauda equina syndrome. Ethics approval was obtained from the University of British Columbia Research Ethics Board
Results
A total of 3142 TSCI patients were identified in the cohort, with 2151 (68.5%) male and an average age of 54 (SD 20.2) years. Of these 1108 (35.3%) patients were 65 years or older at the time of their injury. The average LOS for acute care prior to discharge was 60.6 (SD 103.3) days. Most patients had cervical spine injuries (56.9%) and incomplete neurology (83.9%), with a large proportion of injuries attributable to a fall mechanism (40.5%). Patients with ISS 25 or higher represented 22.5% of the cohort.