Malhotra Armaan K, Essa Ahmad, Jassani Ahad, Shakil Husain, Badhiwala Jetan H, Quon Jennifer L, Ibrahim George M, Dermott Jennifer A, Lebel David E, Kulkarni Abhaya V, Nathens Avery B, Wilson Jefferson R, Witiw Christopher D
1Division of Neurosurgery, St. Michael's Hospital.
2Li Ka Shing Knowledge Institute, Unity Health.
J Neurosurg Pediatr. 2024 Nov 22;35(2):118-127. doi: 10.3171/2024.8.PEDS24313. Print 2025 Feb 1.
Spinal cord injury (SCI) trials have historically underrepresented pediatric patients. There are limited pediatric data examining the influence of surgical timing on complications and mortality for children and adolescents who have sustained complete traumatic SCI.
The following multicenter cohort study used Trauma Quality Improvement Program data from 2010 to 2020. The authors identified pediatric patients (aged < 18 years) who sustained complete traumatic SCI and underwent surgical intervention within 7 days of admission. Propensity score matching was performed between patients who underwent surgery within 24 hours versus ≥ 24 hours. The authors then assessed differences for the following outcomes: major in-hospital complications, immobility-related complications, length of stay (LOS), and mortality.
There were 837 patients with complete traumatic SCI managed across 297 trauma centers identified for study inclusion (70% underwent early surgery). After matching, 494 patients were available for analysis. Patients undergoing delayed surgery experienced longer ICU LOS (mean difference 3.74 days, 95% CI 0.91-6.57 days) and more major in-hospital complications (OR 1.77, 95% CI 1.16-2.73) and immobility-related complications (OR 2.09, 95% CI 1.25-3.56). There were no differences in mortality between groups. Younger age, non-White race, penetrating injuries, lower Glasgow Coma Scale score at admission, severe concomitant abdominal injuries, and motor vehicle collision injury mechanisms were associated with increased time to surgery.
The authors demonstrated an association between early surgery and shorter ICU LOS and reduced in-hospital complications. Future work is needed to quantify the impact of surgical timing on functional neurological outcomes and to explore upstream social determinants of health influencing timing of surgery.
脊髓损伤（SCI）试验历来纳入的儿科患者数量不足。对于遭受完全性创伤性脊髓损伤的儿童和青少年，关于手术时机对并发症和死亡率影响的儿科数据有限。
以下多中心队列研究使用了2010年至2020年创伤质量改进计划的数据。作者确定了年龄小于18岁、遭受完全性创伤性脊髓损伤且在入院7天内接受手术干预的儿科患者。对在24小时内接受手术与≥24小时接受手术的患者进行倾向评分匹配。然后作者评估了以下结局的差异：主要院内并发症、与活动受限相关的并发症、住院时间（LOS）和死亡率。
在297个创伤中心确定了837例接受完全性创伤性脊髓损伤治疗的患者纳入研究（70%接受了早期手术）。匹配后，有494例患者可供分析。接受延迟手术的患者重症监护病房住院时间更长（平均差异3.74天，95%置信区间0.91 - 6.57天），主要院内并发症更多（比值比1.77，95%置信区间1.16 - 2.73）以及与活动受限相关的并发症更多（比值比2.09，95%置信区间1.25 - 3.56）。两组之间死亡率无差异。年龄较小、非白人种族、穿透伤、入院时格拉斯哥昏迷量表评分较低、严重的腹部合并伤以及机动车碰撞损伤机制与手术时间延长相关。
作者证明了早期手术与缩短重症监护病房住院时间以及减少院内并发症之间存在关联。未来需要开展工作来量化手术时机对功能性神经结局的影响，并探索影响手术时机的上游健康社会决定因素。
