Analyzing spinal cord injury patients: Directly admitted compared to individuals transferred into level I trauma...

Regaining a higher degree of function after spinal cord injury (SCI) requires timely diagnosis and intervention. The American College of Surgeons (ACS) guidelines recommend that SCI should be treated in a designated Level I trauma center. Patients may initially go to lower-level trauma centers, delaying care. This study assesses whether the ACS recommendation is achieved by analyzing interhospital transfer (IHT) of SCI patients.

Retrospective study using Pennsylvania Trauma Systems Foundation registry (2010 and 2020) to determine the trend of IHT of SCI patients, demographics, type and cause of trauma, level of SCI, presence of vertebral fracture, degree of SCI (complete vs. incomplete), in-hospital mortality, length of hospital stay, injury severity and discharge dispositions.

Among 7,236 (658/year) patients with SCI between 2010 and 2020, an average of 29% were transferred yearly, while 71% were directly admitted. The mean age of transferred patients was 47.8 years and 45 for direct admissions. IHT rates were: Females 30.9%, males 28.1%; Caucasians 30.5%; fall and vehicle accident victims 34.6 and 34.3%; C5-C7 level injuries 31.8%; single region SCI 29.4% (vs. 26.1% for multiple regions); and incomplete SCI 29.7% (vs. 24.7% complete). In-hospital death was lower for transferred patients (17.3% vs. 82.7%). Length of stay was similar; home and rehab centers were the main destinations after discharge.

The ACS recommendation is challenging to achieve, despite patient demographics, causes of injury, or intrinsic characteristics of SCI. This warrants further study, with a goal to design, execute, and evaluate a mitigation plan.