Impact of U.S. Hospital Center and Inter-Hospital Transfer on Spinal Cord Injury Management: An Analysis of the National Trauma Data Bank

J Trauma Acute Care Surg, 2021 · DOI: 10.1097/TA.0000000000003165 · Published: June 1, 2021

Simple Explanation

Traumatic spinal cord injury (SCI) is a significant public health issue. Outcomes depend on the initial injury's severity, how well secondary effects are managed, and rehabilitation efforts. The study examines the impact of the type of center patients initially present to and whether interhospital transfer influences their management and overall outcomes. Patients admitted to level I trauma centers were more likely to undergo surgery, especially if admitted directly. This suggests that direct admission to trauma centers may improve care.

Study Duration

4 Years

Participants

11,744 incidents of SCI

Evidence Level

Level 3, Retrospective Analysis

Key Findings

1
Patients directly admitted to Level I trauma centers were more likely to receive surgical intervention compared to those admitted to Level II/III/IV centers.
2
Patients transferred to Level I centers showed slightly higher odds of receiving surgery compared to those transferred to Level II/III/IV centers, though this difference was not statistically significant.
3
Patients treated at Level I centers were more likely to be discharged to rehabilitation centers, while those at Level II/III/IV centers were more often discharged home without services.

Research Summary

This study examined the impact of hospital center type and inter-hospital transfer on the management and outcomes of traumatic spinal cord injury (SCI) patients using the National Trauma Data Bank (NTDB). The study found that patients directly admitted to Level I trauma centers were more likely to undergo surgery compared to those admitted to lower-level centers. Level I trauma centers had higher complication rates, but patients treated there were also more likely to be discharged to rehabilitation centers.

Practical Implications

Improved Pre-Hospital Care Pathways

Focus on streamlining pre-hospital care pathways to ensure timely and appropriate care for patients with traumatic SCI.

Standardization of Care

Promote the standardization of care for traumatic SCI patients, especially regarding surgical intervention and rehabilitation.

Direct Admission to Trauma Centers

Encourage direct admission to Level I trauma centers when feasible to potentially improve surgical intervention rates and discharge outcomes.

Study Limitations

1
Retrospective data limits causal inference.
2
Missing data required exclusion.
3
Granularity of clinical data did not include features such as physical exam or ASIA score

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