Impact of US hospital center and interhospital transfer on spinal cord injury management: An analysis of the National Trauma Data Bank

Abstract

BACKGROUND:Traumatic spinal cord injury (SCI) is a serious public health problem. Outcomes are determined by severity of immediate injury, mitigation of secondary downstream effects, and rehabilitation. This study aimed to understand how the center type a patient presents to and whether they are transferred influence management and outcome. METHODS:The National Trauma Data Bank was used to identify patients with SCI. The primary objective was to determine association between center type, transfer, and surgical intervention. A secondary objective was to determine association between center type, transfer, and surgical timing. Multivariable logistic regression models were fit on surgical intervention and timing of the surgery as binary variables, adjusting for relevant clinical and demographic variables. RESULTS:There were 11,744 incidents of SCI identified. A total of 2,883 patients were transferred to a Level I center and 4,766 presented directly to a level I center. Level I center refers to level I trauma center. Those who were admitted directly to level I centers had a higher odd of receiving a surgery (odds ratio, 1.703; 95% confidence interval, 1.47-1.97; p < 0.001), but there was no significant difference in terms of timing of surgery. Patients transferred into a level I center were also more likely to undergo surgery than those at a level II/III/IV center, although this was not significant (odds ratio, 1.213; 95% confidence interval, 0.099-1.48; p = 0.059). CONCLUSION:Patients with traumatic SCI admitted to level I trauma centers were more likely to have surgery, particularly if they were directly admitted to a level I center. This study provides insights into a large US sample and sheds light on opportunities for improving pre hospital care pathways for patients with traumatic SCI, to provide the timely and appropriate care and achieve the best possible outcomes.

Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis

“…After removing duplicates, 4,151 records were screened on title and abstract, resulting in 122 potentially eligible studies. After full-text screening 32 studies were included 21–52 . Three additional studies were identified using reference chasing, 53–55 resulting in 35 included studies for the systematic review; 10 studies on traumatic brain injuries (TBIs), 22,26,29,30,33,45,49,50,53,54 six studies on thoracic injuries, 21,25,27,28,46,55 six studies on abdominal injuries, 34,35,38,47,48,52 three studies on spinal cord injuries, 23,37,41 five studies on lower-extremity injuries, 24,39,40,42,43 and five studies on hemodynamically unstable patients 31,36,44,51,54 …”

“…31 A total of 26 (74%) studies [22][23][24][25][26][27][29][30][31][32][34][35][36][38][39][40][43][44][45][46][47][48][49][50][51][52] compared Level I with Level II trauma centers. Other studies compared Level I with unranked, 54,55 Level I with IV and unranked, 42 Level I/II with III/IV, 21,41 Level I/II with unranked, 53 Level I with III, 33 Level I with II/III/IV, 37 Level I/II/III with unranked. 28…”

“…Of all studies, 21 studies (60%) 22,23,25,26,29,30,[32][33][34][35][37][38][39][43][44][45][46][47][48][49]52 reported ICU LOS comparing higher and lower level trauma centers (Table 1). A total of 10 studies (48%) 22,23,26,30,32,34,37,38,45,48 found lower level trauma centers associated with shorter ICU LOS compared with higher levels, seven studies (33%) 25,29,33,43,44,47,49 reported no significant differences in ICU LOS between higher and lower level trauma centers, and four studies (19%) 35,39,46,52 found a significant lower ICU LOS in Level I trauma centers.…”

“…Of all studies, 26 studies (74%) [21][22][23][25][26][27][28][29][30][31][32][33][34][35][37][38][39][43][44][45][46][47][48][49][50][51][52] reported on HLOS comparing higher with lower level trauma centers, of which 19 studies (73%) 22,23,25,26,[30][31][32]34,35,38,39,[44][45][46][47][49][50][51][52] compared Level I with Level II trauma centers (Table 1). A total of 13 studies (50%) 22,26,28,3...…”

Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury

“…89 Interestingly, a recent study aimed to understand how the center type a patient presents to can influence their management and outcome after a SCI. Williamson et al 90 reported that among a total of 11,744 incidents of SCI, those patients who were admitted directly to level I trauma centers had significantly higher odds of receiving a decompressive surgery compared to those who were either transferred to a level I center or went directly to a level II/III/IV center. As with all major health issues, social factors always play in role in accessibility of care and should be kept in mind when generalizing the results for SCI treatment.…”