|
Citation
|
Samuel AM, Bohl DD, Basques BA, Diaz-Collado PJ, Lukasiewicz AM, Webb ML, Grauer JN. Spine 2015; 40(13): 992-1000. |
|
Affiliation
|
1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510. |
|
Abstract
|
STRUCTURED ABSTRACT: Study Design. A retrospective study of surgically treated cervical spinal cord injury (SCI) patients from the National Trauma Data Bank Research Data Set (NTDB RDS).
OBJECTIVE: To determine how time to surgery differs between SCI subtypes, where delays before surgery occur, and what factors are associated with delays. SUMMARY OF BACKGROUND DATA: Studies have shown that cervical SCI patients receiving surgery within 24 hours after injury have superior neurological outcomes to patients receiving later surgery, with most evidence coming from the incomplete SCI subpopulation.
METHODS: Surgically treated cervical SCI patients from 2011 and 2012 were identified in NTDB RDS and divided into subpopulations of complete, central, and other incomplete SCIs. Relationships between surgical timing and patient and injury characteristics were analyzed using multivariate regression.
RESULTS: A total of 2,636 cervical SCI patients were identified: 803 with complete SCI, 950 with incomplete SCI, and 883 with central SCI. The average time to surgery was 51.1 hours for complete SCI patients, 55.3 hours for incomplete SCI patients, and 83.1 hours for central SCI patients. Only 44% of SCI patients underwent surgery within the first 24 hours after injury, including only 49% of patients with incomplete SCI.The vast majority of time between injury and surgery was after admission, rather than in the emergency department or in the field. Upper cervical injuries and greater Charlson comorbidity index were associated with later surgery in all three SCI subpopulations.
CONCLUSIONS: The majority of SCI patients do not receive surgery within the first 24 hours after injury, and the majority of delays occur after inpatient admission. Factors associated with these delays highlight areas of focus for expediting care in these patient populations.
Language: en |