create the summary of the findings "Material and Methods
A three-year prospective monitoring study
of Iranian veterans with SCI was conducted from
March 20, 2007, to March 19, 2010. International Statistical Classification of Diseases and Related Health Problems – Tenth Revision (ICD-10)
codes were used throughout the study and were
recorded by the physicians. The exclusion criteria
were those patients who were physicians or resided in health-care facilities and whose health status was therefore monitored according to a different protocol.
Routine Monitoring Process
In the present system of veteran care, each veteran has a corresponding general physician. Each
general physician is responsible for five veterans, and oversees their health surveys according
to ICD-10 coding. The survey includes the general physician’s visits, specialist referrals and consultation information (when referred by the general
physician), as well as laboratory tests and imaging
in order to confirm a suspected diagnosis. Routine
monitoring was done each month by the general
physicians. Telephone calls were also used to follow up on medical complications as reported by
the patients. The results of the routine monthly scheduled visits by the general physicians were
recorded. The visits included 20- to 30-min interviews, including a physical examination, followed
by laboratory assessment, distribution of prescriptions and individualized specialist consultations
for each patient. To ensure complete care for all
veterans, routine visits were conducted in the patient’s living quarters in cases of limited mobility
or the veteran’s preference. The annual incidence
of certain ICD-10-defined medical conditions was
derived from the records of the corresponding
general physician for each veteran.
Telephone Survey
A telephone survey was performed to assess
patients’ health-related complaints and any new
diagnoses during January and February of 2010.
Successful calls were made to 125 veterans based
on randomization of their ID numbers. During
the calls veterans were asked about complaints regarding their health status via open-ended questions. Patients were asked what their major health
complaints are; then they were asked if additional medical problems or concerns had developed
since their most recent follow-up with their primary care physician.
Additional Data-Gathering
Outings
In addition to the monitoring, 21 recreational
outings including educational, medical and cultural programs were held for 600 veterans and 1800
of their family members, which provided a further
opportunity to gather health information. Patients
with a common medical status were included on
each trip so that specific educational programs for
their level and type of injury could be provided.
Complications & Complaints of Veterans with SCI 271
Statistical Analysis
A descriptive statistical analysis was performed, including evaluations of the level of injury, medical complications (as ICD-10 codes), subjectively reported medical complaints, mortality
statistics and causes of death. Microsoft Excel (Microsoft Office – 2007) and SPSS software (Version
13 – 2004) were used for the analysis.
In conducting this study the applicable institutional or governmental regulations concerning
the ethical use of human volunteers were followed
during the course of this research.
Results
The total number of Iranian SCI veterans of
the Iraq-Iran war was 1984: 34 females (1.71%)
and 1950 males (98.29%), according to the Iranian national database. In the health-monitoring
study complete records were available for 1506,
1684 and 1803 SCI patients for the years 2007,
2008 and 2009 respectively. The median year of
birth of the SCI veterans was 1964. The mean age
was 46 ± 6.68 by the year 2010. A total of 1873 patients (94.40%) were married. The causes of injury were bullets and shrapnel, road traffic accidents
and city bombardments. Table 1 reveals the distribution of the spinal cord injury levels. Classifying the participants using the American Spinal Injury Association (ASIA) Impairment Scale (AIS),
the majority were ASIA A (complete SPI with no
motor or sensory function preserved in the sacral
segment). Only 174 (8.77%) had incomplete injuries (not separately defined on other ASIA impairment scales).
Monitoring was carried out for three consecutive years, from March 20, 2007, to March 19, 2010.
Table 2 shows descriptive data on the health-related status of the participants, obtained from the
general physicians’ monthly visits. Table 3 presents the data from successful telephone calls addressing the self-reported complaints of SCI veterans. The most frequent complaint in the telephone
survey was related to kidney and/or urologic disorders, while pressure ulcers were the most frequent
problem reported in interviews during the physicians’ monitoring process.
The monitoring and follow-up were carried out
with veterans who suffered SCI during the eightyear period of the Iraq-Iran War (1980–1988) abd
whose injuries had lasted between 23 to 31 years
(median of 27 years). A total of 101 SCI veterans among the 1984 records died between 2000
and 2010, prior to the conclusion of this study. By
March 2010, out of a total of 1984 veterans, 1803
(90.88%) were included in follow-up monitoring,
101 (5.09%) had died, and 77 (3.88%) were lost to
follow up. The causes and numbers of death are
shown in Tables 4 and 5. Among the deceased veterans, the mean duration of injury (in years) was
16.27 for cervical-level injuries, 24.71 for thoraciclevel injuries and 22.00 for lumbar-level injuries."