Rita G. Hamilton D.O.

Sikka, S., L. Callender, S. Driver, M. Bennett, M. Reynolds, R. Hamilton, A. M. Warren and L. Petrey (2018). “Healthcare utilization following spinal cord injury: Objective findings from a regional hospital registry.” J Spinal Cord Med Oct 2: 1-7. [Epub ahead of print].

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OBJECTIVE: The purpose was to describe the prevalence and characteristics of healthcare utilization among individuals with spinal cord injury (SCI) from a Level I trauma center. DESIGN: Retrospective data analysis utilizing a local acute trauma registry for initial hospitalization and merged with the Dallas-Fort Worth Hospital Council registry to obtain subsequent health care utilization in the first post-injury year. SETTING: Dallas, TX, USA. PARTICIPANTS: Six hundred and sixty four patients were admitted with an acute traumatic SCI from January 2003 through June 2014 to a Level I trauma center. Fifty five patients that expired during initial hospitalization and 18 patients with unspecified SCI (defined by ICD-9 with no etiology or level of injury specified) were not included in the analysis, leaving a final sample of 591. OUTCOME MEASURES: Data included demographic and clinical characteristics, charges, and healthcare utilization. RESULTS: Mean age was 46.1 years (+/-18.9 years), the majority of patients were male (74%), and Caucasian (58%). Of the 591 patients, 345 (58%) had additional inpatient or emergency healthcare utilization accounting for 769 additional visits (median of 3 visits per person). Of the 769 encounters, 534 (69%) were inpatient and 235 (31%) were emergency visits not resulting in an admission. The most prevalent ICD-9 codes listed were pressure ulcer, neurogenic bowel, neurogenic bladder, urinary tract infection, fluid electrolyte imbalance, hypertension, and tobacco use. CONCLUSION: Individuals with SCI experience high levels of healthcare utilization which are costly and may be preventable. Increasing our understanding of the prevalence and causes for healthcare utilization after acute SCI is important to target preventive strategies.

Hamilton, R., S. Kirshblum, S. Sikka, L. Callender, M. Bennett and P. Prajapati (2018). “Sacral examination in spinal cord injury: Is it really needed?” J Spinal Cord Med 41(5): 556-561.

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OBJECTIVE: To determine if a self-report measure of S4-5 motor and sensory function in patients with chronic SCI accurately predicts sacral examination results. DESIGN: Prospective, single-blinded self-report survey compared with sacral exam. SETTING: Outpatient SCI clinic. PARTICIPANTS: 116 patients aged 18+ with chronic SCI > 6 months who have undergone sacral exam. INTERVENTIONS: The survey included demographic/clinical and sacral function information such as light tough (LT), pinprick sensation (PP), deep anal pressure (DAP) and voluntary anal contraction (VAC). Survey results and sacral exam were compared and stratified by the patient’s American Spinal Cord Injury Association Impairment Scale (AIS) category. OUTCOME MEASURES: Sacral self-report survey, AIS examination. RESULTS: Mean age was 41.3 +/- 14.4 years with majority male (69%) and Caucasian (71.6%). Overall, Positive Predictive Value (PPV) ranged between 48% (VAC) to 73% (DAP) and Negative Predictive Value (NPV) between 92% (VAC) to 100% (LT). AIS-A had NPV of 100% across all categories, and AIS-D had PPV of 100% across all categories. CONCLUSION: Patient report of sacral sparing can predict negative sensation in patients with AIS-A and predict positive sensation in persons with AIS-D. Overall, the self-report of sacral sparing of motor and sensory function is not predictive enough to rely on for accurate classification.

Shaw, E., D. W. Braza, D. S. Cheng, E. Ensrud, A. S. Friedman, R. G. Hamilton, J. J. Miller, A. S. Nagpal and S. Sharma (2018). “American Academy of Physical Medicine and Rehabilitation Position Statement on Opioid Prescribing.” PM & R. May 15. [Epub ahead of print].

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The American Academy of Physical Medicine and Rehabilitation (AAPM&R) is the national medical organization representing more than 10,000 physicians who are specialists in physical medicine and rehabilitation (PM&R). PM&R physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. PM&R physicians evaluate and treat injuries, illnesses, and disabilities and are experts in designing comprehensive, patient-centered treatment plans. Physiatrists use cutting-edge as well as time-tested treatments to maximize function and quality of life. The AAPM&R recognizes that the current opioid epidemic is one of the most devastating public health threats to our society. With 2 of 3 drug overdose deaths involving an opioid in 2016, we are concerned about the risk that opioids pose to the individual patient and the public at large when not used appropriately. In addition, our specialty recognizes that chronic pain is the cause of suffering for more than 100 million Americans. It is our goal to avoid adverse events associated with opioid usage, including addiction, misuse, abuse, diversion, and death. Our specialty is striving to mitigate overprescribing and to reduce stigma as well as the undertreatment of chronic pain. Many physiatrists are leaders of health care teams that provide essential care for patients presenting with both acute and long-term pain management needs. The physiatrist’s goal is to improve patient quality of life by developing a treatment plan that minimizes pain and maximizes daily functioning. Compelling scientific evidence shows that physical therapy, behavioral health, nonopioid medications, and interventional procedures may be better treatment options compared with opioids alone [3]. We strongly advocate for improvement in access to multimodal treatments for pain. It is vital that payers review their policies to increase the availability of evidence-based, multimodal, nonopioid pain management treatments. (Excerpt from text, p. 2; no abstract available.)