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Days at Home After Traumatic Spinal Cord Injury: An Interpretable Patient-Centered Outcome From Administrative Health
Christopher S Lozano1,2, Vishwathsen Karthikeyan1,2, Barbara Haas3,4
1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Background And Objectives:
Days alive and at home (DAH) is a patient-centered outcome that integrates survival, institutional care utilization, and community dwelling. Although DAH has been validated in other clinical contexts, its validity after traumatic spinal cord injury (SCI) remains unknown. We evaluated DAH at 180 days after injury (DAH180) as a clinically meaningful outcome for traumatic SCI using administrative health data.
Methods:
We conducted a population-based, multicenter retrospective cohort study using linked administrative health data from Ontario, Canada. Adults with acute traumatic SCI admitted to trauma centers between 2009 and 2023 were included. The primary outcome was DAH180; secondary outcomes included DAH at 1 and 2 years. Construct validity was assessed using multivariable quantile regression and associations with rehabilitation discharge motor Functional Independence Measure scores. Predictive validity was evaluated using correlations between DAH180 and subsequent DAH accrual and 1-year healthcare expenditures. Minimum important differences were estimated using distribution- and anchor-based methods.
Results:
The cohort included 693 patients. Median DAH180 was 63 days (IQR 0-118 days), with many patients accruing zero days at home, particularly after cervical complete injuries. Lower median DAH180 was associated with older age, higher injury severity, complete injury, and frailty. DAH180 correlated moderately with motor Functional Independence Measure scores at rehabilitation discharge (ρ = 0.69; 95% CI, 0.63-0.74) and remained independently associated after multivariable adjustment. Among 180-day survivors, DAH180 correlated with subsequent DAH from 180 days to 1 year (ρ = 0.61, 95% CI, 0.55-0.67) and from 1 to 2 years (ρ = 0.47, 95% CI, 0.39-0.53), and was inversely associated with 1-year healthcare expenditures (ρ = -0.41, 95% CI, -0.46 to -0.33). The average estimated minimum important differences was 23 days.
Conclusion:
DAH180 demonstrated construct, predictive, and face validity after traumatic SCI and may provide a feasible, patient-centered outcome for linked population-based administrative data research.
