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  4. Risk factors for 14-day rehospitalization following trauma with new traumatic spinal cord injury diagnosis: A 10-year nationwide study in Taiwan

Risk factors for 14-day rehospitalization following trauma with new traumatic spinal cord injury diagnosis: A 10-year nationwide study in Taiwan

PLoS ONE, 2017 · DOI: https://doi.org/10.1371/journal.pone.0184253 · Published: September 1, 2017

Spinal Cord InjuryHealthcareTrauma

Simple Explanation

This study looked at factors that increase the risk of patients being readmitted to the hospital within 14 days with a new diagnosis of traumatic spinal cord injury (tSCI) after initially being hospitalized for trauma. The study found that patients with less severe injuries, those transferred from other hospitals, and those treated by surgeons who may not specialize in neurotrauma were more likely to be readmitted with a new tSCI diagnosis. These findings suggest that delayed diagnosis of tSCI is not uncommon, especially in patients with less obvious injuries, and that improving diagnostic accuracy and timeliness is crucial.

Study Duration
10 years
Participants
23 617 tSCI patients
Evidence Level
Not specified

Key Findings

  • 1
    Interhospital transfer was a significant risk factor for 14-day rehospitalization with new tSCI diagnosis.
  • 2
    Patients with severe or profound injuries were significantly less likely to be rehospitalized with a new tSCI diagnosis compared to those with minor or moderate injuries.
  • 3
    Injuries at the thoracic, lumbar, and multiple levels were significant risk factors for 14-day rehospitalization with new tSCI diagnosis compared to injury at the cervical level.

Research Summary

This nationwide study in Taiwan identified risk factors for 14-day rehospitalization with new traumatic spinal cord injury (tSCI) diagnosis, using it as an indicator of diagnostic quality during the first hospitalization. The study found that interhospital transfer, injuries at specific spinal levels, and treatment by non-neurosurgeons were associated with increased risk of rehospitalization with a new tSCI diagnosis. The findings suggest that delayed tSCI diagnosis is more common in patients with less severe injuries and those transferred from lower-level hospitals, emphasizing the need for improved diagnostic protocols and awareness among trauma care providers.

Practical Implications

Improved Diagnostic Protocols

Implement and validate evidence-based decision rules to improve the diagnostic quality of traumatic thoracolumbar SCI.

Enhanced Trauma Care Awareness

Educate all surgeons involved in trauma care to recognize occult signs of tSCI, especially in patients with brain, chest, or extremity injuries.

Optimized Interhospital Transfer

Improve the screening and diagnostic capabilities at lower-level hospitals to minimize the risk of transferring patients with undiagnosed tSCI.

Study Limitations

  • 1
    Lack of clinical data (physical or neurological examination records, images, and laboratory test results) in the NHIRD.
  • 2
    Restriction of the sample to first-time hospitalized trauma patients.
  • 3
    Potential differences in health care systems and SCI classification may limit the generalizability of the results to other countries.

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