METHODS Prospective 2 years survey from 1 February 1997 to 31 January 1999. OBJECTIVE To assess the incidence of complications during the acute stage of spinal cord lesions and the possible correlations between them and the type of care and rehabilitation provided. METHODS Spinal cord injured patients consecutively admitted to 37 Italian Rehabilitation Centres (RCs). METHODS The study population was drawn from the GISEM (Italian Group for the Epidemiological Study of Spinal Cord Injuries) study (1997-1999), which involved the participation of 37 RCs and Spinal Units (SUs), situated all over Italy, mainly in the northern and central part of the country. Only patients admitted within 60 days from the traumatic injury were considered. This yielded a population of 588 patients (18% females and 82% males). Six of the most common complications were considered: trophic skin changes, heterotopic ossifications, urinary complications, respiratory complications, deep-vein thrombosis and pulmonary embolism. RESULTS Results revealed a high incidence of trophic skin changes (23.3%), while over half of the patients presented at least one of the complications under examination. Trophic skin changes occurred exclusively among the patients whose admission to the SUs had been delayed or who had received initial treatment in nonspecialised Centres. CONCLUSIONS Optimal rehabilitation care, with regard to the prevention of complications during the acute phase, entails early admission to a specialised multidisciplinary facility, namely an SU.