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

BackgroundTimely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury, and expeditious transfer to a specialist spinal cord injury unit is recommended within 24 hours from injury. Previous research in New South Wales found only 57% of TSCI patients were admitted to specialist spinal cord injury unit for acute post-injury care; 73% transferred within 24 hours from injury. We evaluated pre-hospital and inter-hospital transfer practices to identify opportunities for improving care delivery. MethodsThis record linkage study included administrative pre-hospital, admissions and costs data for all patients aged ≥16 years with incident traumatic spinal cord injury in New South Wales (2013-2016). We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods to better understand the post-injury care pathways impact on patient outcomes.ResultsInclusion criteria identified 316 patients, geospatial 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 specialist spinal cord injury unit. Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to specialist spinal cord injury unit (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p<0.001).ConclusionsGetting patients with acute traumatic spinal cord injury 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 specialist spinal cord injury unit transfer for patients injured within 60 minutes radius, enabling the benefits of specialised care.