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To evaluate the epidemiologic change of patients with spinal cord injury who were admitted to a Rehabilitation Hospital, Yonsei University College of Medicine, during 1987-1996 and 2004-2008.
Medical records of 629 patients with spinal cord injury admitted to the Rehabilitation Hospital, Yonsei University College of Medicine, from 2004 to 2008 were collected and reviewed retrospectively.
The male-to-female ratio decreased to 2.86:1, the mean age at injury increased, nontraumatic etiology increased, traffic accident remained to be the most common in traumatic spinal cord injury, and falling increased significantly. Tumor was the most common etiology in nontraumatic spinal cord injury, tetraplegia and incomplete injuries occurred more than paraplegia and complete injuries, indwelling catheter was the most common voiding method, and the duration of hospitalization decreased.
Many trends changed in epidemiology of spinal cord injury.
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Method: We performed a prospective study on 1370 cases of stroke consecutively admitted to the hospital from June, 2001 to May, 2002 during hospitalization by medical records and questionaire.
Results: The highest incidence of the stroke was noted in the group of 60 years of age. The proportion of stroke subtypes were infarct (75.2%), intracranial hemorrhage (21.2%), and subarachnoid hemorrhage (3.6%). Sixteen percents of patients arrived over 24 hours after onset of stroke. The seasonal incidence was in order of frequency of spring, winter, autumn, and summer. The highest occurrence of the stroke was noted in May. The onset time of stroke was highest between 7：00 am and 8：00 am. Risk factors in stroke by the order of frequency were hypertension (61.1%), abnormal EKG at admission (45.5%), hyperlipidemia (38.3%), smoking (36.6%), previous stroke history (24.7%), and diabetes mellitus (24.7%). The common complications during hospitalization were pneumonia (7.6%), gastritis (5.6%), depression (4.8%), and hepatitis (4.6%).
Conclusion: Although the results of this study obtained from one local hospital in Korea, they are valuable as basic epidemiologic data of stroke for the prospective community- based study in the future. (J Korean Acad Rehab Med 2003; 27: 178-185)
Objective: The patients with spinal cord injury (SCI) suffered by a lot of complications that influence the quality of life both physically and mentally. The purpose of this study was to evaluate the epidemiology of patients with spinal cord injury in incidence of the complication according to the injury level and period.
Method: Retrospective study was done in 554 patients with SCI who discharged from Yonsei University Medical Center from January, 1987 to December, 1996. We investigated the incidence of each complication such as respiratory, cardiovascular, genitourinary, musculoskeletal, and dermatologic complications according to the neurologic level and each period (1987∼1991, 1992∼1996).
Results: Among the 554 cases, urologic complication (40.3%) was the most common complication followed by dermatologic (39.0%), musculoskeletal (33.6%), cardiovascular (27.1%) and so on. The most common complications of each system were autonomic dysreflexia (13.2%) in cardiovascular, pneumonia (9.6%) in respiratory, contracture (27.8%) in musculoskeletal, urinary tract infection (34.3%) in urologic, hemorrhoid in gastrointestinal, and central pain (24.0%) in neurogenic complications. The most common site of pressure sore was sacral area (58.9%). There was no significant difference in each complication according to the injury period.
Conclusion: Urologic complication was the most prevalent in patients with SCI followed by dermatologic, musculoskeletal and so on. These basic results would be helpful for prevention and management of the complication of SCI.
Objective: Fracture has been reported as one of complicated problems in stroke patients. The purpose of this study is to provide epidemiologic data on fractures in stroke patients and investigate the specific feature of these fractures.
Method: Stroke patients treated in Dong-Eui hospital due to fracture after stroke from March 1990 to March 1999 were enrolled in this study, and the retrospective study of fracture was performed on these patients.
Results: Subjects were 73 fracture patients with history of previous stroke. There were 50 patients with ischemic stroke and 23 patients with hemorrhagic stroke. And 35 patients were right hemiplegia, 38 patients were left hemiplegia. In this study, the causes of fracture were slip (63 cases, 86.3%), fall (6 cases, 8.2%), range of motion exercise (3 cases, 4.1%), and crushing injury (1 case, 1.4%). The frequency of fracture in patients who walk independently or with minimal to moderate assist was higher than in patients who walk with maximal assist or were bed-ridden state. In 65 patients, the fracture occured on the same side of hemiplegia. The distribution of fracture site was femur (45 cases, 61.6%), humerus (12 cases, 16.4%), and radius (3 cases) in the order of frequency. The interval between stroke and occurrence of fracture were less than 6 months in 34 cases (46.6%), 6 months to 1 year in 10 cases (13.7%), 1 to 2 years in 13 cases (17.8%), and 2 to 20 years in 16 cases (21.9%).
Conclusion: As with our study, the fracture in stroke patient tend to occur within the first year after a stroke as a result of slip and the most frequently affected site is femur of hemiplegic side.
Objective: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a rehabilitation hospital.
Method: Two hundred nine consecutive admissions to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated.
Results: Twenty four (11.5%) experienced at least one fall, and most of the falls occurred in their own room during walking. Risks for falls were associated with the presence of the sensory or cognitive function disturbance, the ability of walking, the use of antihypertensive drug, and presence of caregiver hired by the patient. No injury was observed in 25 (76%) of total 33 incidents, and 8 falls (24%) caused mild injury - pain, and simple contusion. There was no fracture or intracerebral hemorrhage.
Conclusion: These data suggest that high risk groups of patients who are prone to the falls within the rehabilitation setting can be identified for the prevention, and afterward for preventive measures.
Objective: The purpose of this study is to present epidemiological data on patients with spinal cord lesion admitted to the Rehabilitation Hospital, YUCM.
Method: Review of medical records of 590 patients with spinal cord injury admitted to the Rehabilitation Hospital, YUCM from 1987 to 1996 retrospectively.
Results: 1) Sex: Males account for 79.6% of the SCI patients. 2) Age: The largest number of injuries occurs in the 20∼29 years of age group (32.5% of patients). 3) Etiology: Trauma accounts for 91.2% of all spinal cord injuries. The leading causes of traumatic spinal cord injury are traffic accidents (57.6%) and falls (26.4%). 4) Level of injury: Complete tetraplegia accounts for 20.5% of all SCI patients, incomplete tetraplegia 23.9%, complete paraplegia 38.8% and incomplete paraplegia 16.5%. In tetraplegics, incomplete injuries increased from 40% in 1987∼1991 to 56.7% in 1992∼1996. 5) Methods of bladder management: 87% of patients voids by reflex. Intermittent catheterization is practiced by 8% of patients
Conclusion: Epidemiologic data of 590 patients admitted to the Rehabilitation Hospital, YUCM, from 1987 to 1996 is presented with changes of epidemiology in each period. The patients suffered SCI from trauma, and traffic accidents and sports as causes were increasing. Female patients and incomplete injuries were also increasing. Mean duration of hospitalization decreased.
Objective: This study was designed to investigate whether the stroke occurrence is influenced by the seasonal and diurnal changes and also to know if the seasonal factor affects the functional outcome of stroke patients.
Method: We analyzed the epidemiologic, etiologic, and clinical data collected from the chart reviews in 824 stroke patients who were admitted to the Asan Medical Center from April 1995 to May 1997.
Results: The highest incidence of the stroke was noted in the group of 60 years of age with the ratio of male to female, 1.27 : 1. The occurrence rate of ischemic stroke (60.4%) was higher than that of hemorrhagic stroke (34.9%) or other type stroke (4.7%).
The highest occurrence of stroke was noted during the months of January and November. The seasonal preference was winter and autumn followed by summer and spring. The onset of stroke was relatively high between 6:00 am and 6:00 pm with regard to the diurnal variance. The functional improvement was not significantly affected by the seasonal change.
Conclusion: The stroke occurred more in winter and autumn than in other seasons. And the functional recuperation was not influenced by the seasonal variation. A further multicenter prospective study using stroke registry would bring more precise and valuable informations.
Objective: The purpose of this study is to present the epidemiological data on patients with a stroke admitted to the severance hospital, Yonsei University College of Medicine (YUMC) and to investigate the significant risk factors of stroke.
Methods: We reviewed medical records of 532 patients with a stroke admitted to the hospital of from 1992 to 1996 retrospectively.
Results: The incidence was highest in the sixth decade. Ischemic stroke (64.3%) was more common than a hemorrhagic stroke (35.7%) and the thrombotic infarction was the leading type (28.3%) of all kinds of stroke. Middle cerebral arterial territory was the most commonly involved site for the thrombotic and embolic stroke. Of the intracerebral hemorrhages, basal ganglia (48.4%) was the most commonly involved site with was followed by the thalamus (24.2%), lobar (19.3%), and cerebellum (6.5%). In subarachnoid hemorrhages, the aneurysm was most frequently located in the middle cerebral artery (34.4%). The possible contributing factors of stroke were hypertension, hypercholesterolemia, cigarette smoking and diabetes mellitus. The common complications during hospitalization were the frozen shoulders, depression, pneumonia, reflex sympathetic dystrophy (RSD), and hydrocephalus.
Conclusion: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.
Objective: To provide epidemiologic data of the pressure sores and to determine the most effective prevention and treatment methods.
Method: Seventy patients with pressure sores who were admitted to the Rehabilitation Hospital, Yonsei University College of Medicine from 1991 to 1995 were included in this study.
Results: The average age of the patients was 36. Traffic accident was the most common(46 cases) cause of injury, followed by falling injury. Thirty-one patients developed pressure sores at home, while 39 patients in various hospitals. According to Frankel's classification, 51 cases were Frankel A, 13 cases were Frankel B, 5 cases were Frankel C and none was Frankel D. Sacrum was the most common site of the sore followed by buttock, ischial tuberosity, greater trochanter, and coccyx. Among many factors investigated, the anemia and hypotension had a significant correlation with the healing time. The treatment methods were variable among the patients depending on the size and severity of the sores. The severe and larger lesions required more surgical managements.
Conclusion: The results support that an intensive prevention is necessary at homes as well as at the hospitals. More educational programs should be provided not only for the patients, but also for the hospital personnels.
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