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Kheman Hara
This is a summary of a study conducted with ICORD researchers Dr. Andrei Krassioukov and MD/PhD student Jordan Squair. Click here to get access to the original article, published in Journal of Neurotrauma.
What is Autonomic Dysreflexia (AD)?
AD is a life-threatening condition that can develop as a common secondary condition for people with spinal cord injuries. It is triggered by an overstimulation of the autonomic nervous system—the system responsible for all unconscious bodily functions such as the heart control and breathing. AD is onset from stimuli below the level of the injury (for example, a full bladder or broken bones), and its symptoms include an increased heart rate and a spike in blood pressure. If left untreated, it can lead to stroke, cardiovascular disease, and possibly death.
Why analyze cases of AD?
A spinal cord injury (SCI) can cause a number of dysfunctions and complications, one reason why so many resources must be allocated to the recovery of the patient. The average lifetime cost of a traumatic SCI can range from one million to a few million dollars, and although AD is one of the most common conditions experienced by a patient with SCI, there is little information on the costs associated with it. As the resources available in the healthcare system are limited, this study helps understand how those resources can be better used. Recognizing the symptoms of AD early and treating it quickly and effectively can significantly help reduce the costs and allocate vital resources to other patients in need. This paper examines where and how those resources might be saved for AD.
How the study was conducted:
The data was collected from two tertiary care centres in Canada, and to determine the actual cost of AD, an activity-based approach was used. Data was recorded only from patients who presented to the emergency room with symptoms of AD and were later diagnosed with it. The patients were all male with ages ranging from 21 to 68 years old. Each patient had SCI at either the thoracic or cervical level, with the time since injury for the patients ranging from 7 months to 40 years. Data was collected on the tests performed on the patient from the moment they entered the emergency room until the time they were discharged, as well as on their length of stay and the number of health care professionals involved. The cost of care was then estimated using the British Columbia Medical Services Commission (MSC) Payment Schedule.
What did they find?
Estimating the financial costs involved with AD is an important step towards lessening its burden. It was found that more than 90% of the costs for a patient with AD came solely from accommodations at the hospital. The costs per patient varied largely, but the total median cost of AD for a patient was just over $5,000. Inefficient practices or a late diagnosis of AD can lead to many complications for a patient that may increase their length of stay, exponentially increasing the economic burden of their care on the health care system. For example, the cost of AD on the healthcare system for a patient with a stay that lasted more than one week had an average cost of about $38,000, whereas a patient with a stay of less than a week cost a fraction of that, at about $4,000.
How can the cost be reduced and what can be done?
Educating and training staff on recognizing cases of AD and the development of pharmaceutical drugs specifically for treating the symptoms would be the first step towards speeding up care for patients with this condition. In fact, this team has already begun the process of educating medical staff about AD along with implementing the use of new therapeutics and pharmaceuticals. Although on a general scale, incidence rates are low for SCI, the condition adds a considerable strain on available resources. Learning new ways to treat and diagnose AD earlier can certainly help diminish avoidable costs and allow those resources to be left for those in need.
