A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in NSW, Australia: a whole population record linkage study

Abstract

Background Timely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 hours from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 hours from injury. Methods This record linkage study included administrative pre-hospital, admissions and costs data for all patients aged ≥16 years with incident TSCI in NSW (2013-2016). Its aim was to examine potential geographical disparities in access to specialist care following TSCI using geospatial methods, and to better understand the impact of post-injury care pathways on patient outcomes. Results Of 316 cases with geospatial data, injury location analysis showed that over half (53%, n=168) of all patients were injured within 60 minutes road travel of a SCIU, yet only 28.6% (n=48) were directly transferred to a SCIU. Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p<0.001). Conclusions Getting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 minutes radius, enabling the benefits of specialised care.