Processes and outcomes of acute care: towards strengthening health systems for acute survivors of traumatic spinal cord injury in South Africa Conran Joseph1,2,

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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 Email: conran.joseph@ki.se Telephone: +27 72371 9276