| Lack of improvement after audit assessing the management of voiding dysfunction in patients with spinal cord injury: necessity for institutional guidelines. | |
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MedLine Citation:
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PMID: 21278004 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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INTRODUCTION: Standard management guidelines for voiding dysfunction in patients with spinal cord injury (SCI) do not exist and these patients are managed on the basis of institutional protocols or individual judgment of managing physicians. OBJECTIVES: To notice general trends and improvements over a five year period, in the institutional practices related to management of voiding dysfunction in SCI patients. METHODOLOGY: A retrospective cross-sectional study conducted by Neurosurgery and Urology services together. A nine year (June 1995-June 2004) internal clinical audit of urological management of SCI patients was compared with a similar audit conducted five years later (January 2008 to June 2010). Comparisons were made using chi square test. A p value of <0.05 was considered statistically significant. RESULTS: A total of 146 patients were compared (89-pre audit, 57-post audit). The quality of documentation of examination findings worsened over the two study periods (p=0.002). Although determination of baseline serum creatinine improved to statistically significant levels (p=0.019), no imaging for the kidneys was performed as baseline in the post audit period (p=0.000). Similarly the number of urodynamic studies performed decreased from 11% to 1.75% (p=0.045). The number of urological consultations, however, increased from 26% to 31.58% (p=0.452). During follow up, only 17 (19.1%) patients in the pre audit study period and 6 (10.5%) in the post audit study period were voiding spontaneously. CONCLUSION: Our study of two eras clearly demonstrated a worsening trend in quality of patient management, which can be corrected by agreeing upon and implementing standard guidelines for management of SCI patients. |
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Authors:
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Syed Johar Raza; Muhammad Shahzad Shamim; Saniya Siraj Godil; S Raziuddin Biyabani; Muhammad Ehsan Bari; Rajesh Kumar; Atta Ul Aleem Bhatti; Saeed Soomro Late |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-1-25 |
Journal Detail:
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Title: International journal of surgery (London, England) Volume: - ISSN: 1743-9159 ISO Abbreviation: - Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-1-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101228232 Medline TA: Int J Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011. Published by Elsevier Ltd. |
Affiliation:
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Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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