Wilson Jefferson R, Voth Jennifer, Singh Anoushka, Middleton James, Jaglal Susan B, Singh Jeffrey M, Mainprize Todd G, Yee Albert, Fehlings Michael G
1 Division of Neurosurgery and Spinal Program, University of Toronto , Toronto, Ontario, Canada .
2 Institute of Clinical Evaluative Sciences, University of Toronto , Toronto, Ontario, Canada .
J Neurotrauma. 2016 May 15;33(10):963-71. doi: 10.1089/neu.2015.4258. Epub 2016 Feb 11.
Early access to specialized care after acute traumatic spinal cord injury (SCI) is associated with improved outcomes. However, many SCI patients do not receive timely access to such care. To characterize and quantify patients' pathway to definitive care and surgery post SCI, and to identify factors that may delay expeditious care, a population based cohort study was performed in Ontario. Using provincial administrative health data, adult patients with acute traumatic SCI who underwent surgery between 2002 and 2011 were identified using SCI specific ICD-10 codes. The relationship between predictor variables and a) time to arrival at the site of definitive care and b) time to surgery was statistically evaluated. Of 1,111 patients meeting eligibility criteria, mean times to arrival at the site of definitive care and to surgery were 8.1 ± 25.5 and 49.4 ± 65.0 hours respectively, with 53.3% of patients having surgery prior to 24 hours. While most patients (88.4%) reached the site of definitive care within 6 hours, only 34.2% reached surgery within 12 hours of arrival. Older age (IRR = 1.01; 95% CI: 1.01, 1.02), increased number of stops at intermediate health care centers (IRR = 7.70; 95% CI: 7.54, 7.86), higher comorbidity index (IRR = 1.43; 95% CI: 1.14, 1.72) and fall related SCI etiology (IRR = 1.16; 95% CI: 1.02, 1.29) were associated with increased time to arrival at definitive care. For surgery, increased age (OR = 1.02; 95% CI: 1.01, 1.03) and stops at intermediate health centers (OR = 2.48; 95% CI: 1.35, 4.56) were associated with a greater odds of undergoing late surgery (>24hrs). These results can inform policy decisions and facilitate creation of a streamlined path to specialized care for patients with acute SCI.
急性创伤性脊髓损伤（SCI）后尽早获得专科护理与改善预后相关。然而，许多SCI患者未能及时获得此类护理。为了描述和量化SCI患者获得确定性治疗和手术的途径，并确定可能延迟快速治疗的因素，在安大略省进行了一项基于人群的队列研究。利用省级行政卫生数据，通过SCI特定的ICD-10编码识别出2002年至2011年间接受手术的急性创伤性SCI成年患者。对预测变量与a）到达确定性治疗地点的时间和b）手术时间之间的关系进行了统计学评估。在1111名符合资格标准的患者中，到达确定性治疗地点和手术的平均时间分别为8.1±25.5小时和49.4±65.0小时，53.3%的患者在24小时内接受了手术。虽然大多数患者（88.4%）在6小时内到达了确定性治疗地点，但只有34.2%的患者在到达后12小时内接受了手术。年龄较大（风险比[IRR]=1.01；95%置信区间[CI]：1.01，1.02）、在中级医疗中心停留次数增加（IRR=7.70；95%CI：7.54，7.86）、合并症指数较高（IRR=1.43；95%CI：1.14，1.72）以及与跌倒相关的SCI病因（IRR=1.16；95%CI：1.02，1.29）与到达确定性治疗的时间增加相关。对于手术，年龄增加（优势比[OR]=1.02；95%CI：1.01，1.03）和在中级医疗中心停留（OR=2.48；95%CI：1.35，4.56）与接受延迟手术（>24小时）的几率增加相关。这些结果可为政策决策提供参考，并有助于为急性SCI患者创建一条简化的专科护理途径。
