Smith 2002
UK
Observational
N=800

Population: Patients that received rehabilitation within the UK National Health Service.
Treatment: Spinal cord injured patients who received rehabilitation from either a specialized spinal injury units (SIU) or non-specialized spinal injury units completed a postal self report questionnaire.
Outcome Measures: Functional outcome, satisfaction, social activity.

• 13.6% of patients did not use the SIU system.
• SIU group had significantly lower:
• Superficial pressure sores (p=0.048).
• Need for assistance in grooming (p=0.004), eating (p=0.001), and drinking (p<0.001) in patients with complete tetraplegia.
• Patients in SIU group were significantly more satisfied with the amount of assistance received (p=0.017).
• SIU group was more likely to have:
• A partner (p=0.012).
• Paid employment (p=0.017).
• Voluntary employment (p=0.025).
• Satisfaction with sex in both tetraplegics (p=0.006) and paraplegics (p=0.05).
• No significant difference was seen in general life satisfaction between the two groups.

Tator et al. 1995
Canada
Case Control
Initial N=552;
Final N=552

Population: Traumatic SCI; 201/220 consecutive admissions to a newly established specialized interdisciplinary acute SCI unit vs 351 admissions to one of two general hospital trauma units; tetraplegia, paraplegia; incomplete, complete; Male/female ~ 4/1; Median age - 27 years (SCI Specialist unit), 32.0 years (general hospital).
Treatment: Comparison of those treated in a SCI specialist spinal unit  (1973-1981) vs a general hospital trauma unit (1947-1973).
Outcome Measures: LOS, Mortality rate, Cord Injury Neurological Recovery Index. All collected at 6 months (complete) or 12 months (incomplete).

• Subjects who were admitted to the specialized SCI unit had significantly shorter acute care LOS than those admitted to the general units (p<0.001). Within the specialized unit subsample, an increased delay from accident to admission resulted in longer LOS (p=0.032).
• Subjects who were admitted to the specialized SCI unit had significantly reduced mortality than those admitted to the general units (p=0.022). This was especially evident in those with complete SCI.
• Subjects who were admitted to the specialized SCI unit had significantly greater neurologic recovery (p<0.001).

Heinemann et al. 1989
USA
Case Control
Initial N=338;
Final N=338

Population:  338 SCI admitted to Rehabilitation, paraplegia, tetraplegia, complete, incomplete.
Treatment: N=185 initially treated in a specialized short-term acute care unit; Control: N=153 initially treated in general hospitals.
Outcome Measures: Modified Barthel index (MBI), MRSCICS Patient Functional Level Scheme, Length of Rehabilitation Stay (LOS), Efficiency of Rehabilitation Gains (MBI / natural logarithm of LOS)

• Those receiving specialized care made functional gains with significantly greater efficiency and were transferred to rehabilitation significantly faster (p<.001).
• A significantly greater number of people were transferred from general centers with spine instability than from specialized SCI centers (p=.02).
• There was no difference between specialized and general acute care with respect to functional status at rehabilitation admission or discharge nor on rehabilitation LOS.

Yarkony et al. 1985
USA
Case Control
Initial N=181;
Final N=181

Population: Traumatic SCI admitted to a specialized rehabilitation unit; Males (n=149) and females (n=32); Avg age 28 years; Tetraplegia (54%), paraplegia (46%); incomplete (58%), complete (42%).
Treatment: Comparison of those treated acutely in a specialized interdisciplinary spinal unit (n=90) vs a general hospital unit (n=91).
Outcome Measures: Joint motion, time to rehabilitation admission, all collected at admission to rehabilitation.

• Those admitted from the specialized SCI unit had significantly improved joint motions (i.e., reduced contractures). More had normal range of motion (p<0.05) and fewer abnormalities.
• Those admitted from the specialized SCI unit were admitted significantly earlier for rehabilitation as compared to those admitted from the general hospital unit (p<0.01). Those admitted earlier to rehabilitation had reduced numbers of contractures (p<0.01).
• Those with tetraplegia had an increased incidence of contractures (p<0.01).

Donovan et al. 1984
USA / Australia
Case Control
Initial N=1,672;
Final N=1,672

Population: Traumatic SCI, admitted to a specialized, integrated rehabilitation unit in Australia (n=66) vs those admitted to the US Model Systems (n=1606); tetraplegia, paraplegia; incomplete, complete.
Treatment: Those treated in an integrated, specialized interdisciplinary spinal unit (Australia) admitted <48 hours post-injury vs those admitted to the US Model Systems at 1-15, 16-30, 31-45 or 46-60 days post-injury (reflecting progressively less specialized care).
Outcome Measures: Incidence of 7 complications collected at 1-15, 16-30, 31-45 or 46-60 days post-injury.

• Subjects who were cared for in the integrated, specialized unit (Australia) encountered the fewest complications. (no statistical analysis was performed)
• People sustained progressively more complications with longer periods of delayed admission (US Model Systems). Individuals admitted at these longer delays were cared for initially in general hospital units.