Middleton James M, Sharwood Lisa N, Cameron Peter, Middleton Paul M, Harrison James E, Brown Doug, McClure Rod, Smith Karen, Muecke Sandy, Healy Sarah
The University of Sydney, Sydney, Australia.
John Walsh Centre for Rehabilitation Research, Sydney, Australia.
BMC Health Serv Res. 2014 Dec 5;14:600. doi: 10.1186/s12913-014-0600-7.
Traumatic spinal cord injury is a devastating condition impacting adversely on the health and wellbeing, functioning and independence, social participation and quality of life of the injured person. In Australia, there are approximately 15 new cases per million population per year; economic burden estimates suggest 2 billion dollars annually. For optimal patient outcomes expert consensus recommends expeditious transfer ("<24 hours of injury") to a specialist Spinal Cord Injury Unit, where there is an interdisciplinary team equipped to provide comprehensive care for the many and complex issues associated with traumatic spinal cord injury. No study of this patient population has been undertaken, that assessed the extent to which care received reflected clinical guidelines, or examined the patient journey and outcomes in relation to this. The aims of this study are to describe the nature and timing of events occurring before commencement of specialist care, and to quantify the association between these events and patient outcomes.
The proposed observational study will recruit a prospective cohort over two years, identified at participating sites across two Australian states; Victoria and New South Wales. Included participants will be aged 16 years and older and diagnosed with a traumatic spinal cord injury. Detailed data will be collected from the point of injury through acute care and subacute rehabilitation, discharge from hospital and community reintegration. Items will include date, time, location and external cause of injury; ambulance response, assessments and management; all episodes of hospital care including assessments, vital signs, diagnoses and treatment, inter-hospital transfers, surgical interventions and their timing, lengths of stay and complications. Telephone follow-up of survivors will be conducted at 6, 12 and 24 months.
There is limited population level data on the effect of delayed commencement of specialist care (>24 hours) in a Spinal Cord Injury Unit. Examining current health service and clinical intervention pathways in this Australian population-based sample, in relation to their outcomes, will provide an understanding of factors associated with patient flow, resource utilisation and cost, and patient and family quality of life. Barriers to streamlined effective early-care pathways and facilitators of optimal treatment for these patients will be identified.
创伤性脊髓损伤是一种极具破坏性的疾病，会对伤者的健康、幸福、功能和独立性、社会参与度以及生活质量产生不利影响。在澳大利亚，每年每百万人口中约有15例新发病例；经济负担估计约为每年20亿澳元。为实现最佳患者预后，专家共识建议迅速（“受伤后<24小时”）转至脊髓损伤专科病房，该病房有跨学科团队，能够为与创伤性脊髓损伤相关的诸多复杂问题提供全面护理。尚未有针对该患者群体的研究评估所接受的护理在多大程度上符合临床指南，或考察与此相关的患者就医过程及预后。本研究的目的是描述专科护理开始前发生事件的性质和时间，并量化这些事件与患者预后之间的关联。
拟进行的观察性研究将在两年内招募一个前瞻性队列，研究对象来自澳大利亚两个州（维多利亚州和新南威尔士州）的参与地点。纳入的参与者年龄在16岁及以上，被诊断为创伤性脊髓损伤。将从受伤之时起，通过急性护理、亚急性康复、出院及社区重新融入等阶段收集详细数据。项目将包括日期、时间、受伤地点和外部致伤原因；救护车响应、评估和处理；所有住院护理阶段，包括评估、生命体征、诊断和治疗、院间转运、手术干预及其时间、住院时长和并发症。将在6个月、12个月和24个月时对幸存者进行电话随访。
关于脊髓损伤专科病房专科护理延迟开始（>24小时）的影响，人群层面的数据有限。在这个基于澳大利亚人群的样本中，考察当前的医疗服务和临床干预路径及其预后，将有助于了解与患者流程、资源利用和成本以及患者和家庭生活质量相关的因素。将确定这些患者简化有效的早期护理路径的障碍以及最佳治疗的促进因素。
