From the Department of Neurosurgery (T.W., S.H., M.G., C.I.S., C.R.G., I.O.K., S.L., M.A.-.E.-B.), Duke University School of Medicine; Department of Biostatistics and Bioinformatics (L.Z.Y., H.-.J.L.), Duke University; and Kentucky Spinal Cord Injury Research Center, Department of Neurosurgery (B.U., M.B.), School of Medicine, University of Louisville, Durham, North Carolina.
J Trauma Acute Care Surg. 2021 Jun 1;90(6):1067-1076. doi: 10.1097/TA.0000000000003165.
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.
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.
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).
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.
Care management, Level IV.
外伤性脊髓损伤（SCI）是一个严重的公共卫生问题。结果取决于损伤的严重程度、继发性下游效应的减轻以及康复情况。本研究旨在了解患者就诊中心的类型以及是否转院对治疗和结果的影响。
利用国家创伤数据库确定 SCI 患者。主要目的是确定中心类型、转院和手术干预之间的关联。次要目的是确定中心类型、转院和手术时机之间的关联。使用多变量逻辑回归模型，将手术干预和手术时机作为二项变量进行拟合，调整了相关的临床和人口统计学变量。
共确定了 11744 例 SCI 事件。共有 2883 例患者转至一级中心，4766 例直接到一级中心就诊。一级中心是指一级创伤中心。那些直接到一级中心就诊的患者接受手术的可能性更高（比值比，1.703；95%置信区间，1.47-1.97；p<0.001），但手术时机没有显著差异。转至一级中心的患者接受手术的可能性也高于二级/三级/四级中心的患者，尽管这并不显著（比值比，1.213；95%置信区间，0.099-1.48；p=0.059）。
外伤性 SCI 患者入院到一级创伤中心的患者更有可能接受手术，尤其是直接入院到一级中心的患者。本研究提供了一个大型美国样本的见解，并阐明了改善外伤性 SCI 患者院前护理途径的机会，以提供及时和适当的护理，并实现最佳的结果。
护理管理，四级。
