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  4. Trends in the presentation and management of traumatic spinal cord lesions above T6: 20-Year experience in a tertiary-level hospital in Spain

Trends in the presentation and management of traumatic spinal cord lesions above T6: 20-Year experience in a tertiary-level hospital in Spain

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1851857 · Published: January 1, 2022

Spinal Cord InjuryCritical CarePublic Health

Simple Explanation

This study examines how traumatic spinal cord injuries (ATSCI) above the T6 level have changed over 20 years in a Spanish hospital's ICU. It looks at who is getting these injuries, what causes them, and how this impacts the use of ICU resources, length of stay, and survival rates. The study found that patients with ATSCI above T6 admitted to the ICU are increasingly older, have more pre-existing health conditions, and are more likely to have been injured in a fall. Despite these changes, the length of time patients spend in the ICU has decreased, and mortality rates have not increased. These findings are important for planning healthcare resources, creating prevention strategies, and understanding the evolving needs of this specific patient population. They highlight the need to adapt treatment approaches to the changing demographics and injury patterns of people with ATSCI.

Study Duration
20 Years
Participants
241 persons with an ATSCI above T6
Evidence Level
Retrospective observational study

Key Findings

  • 1
    The mean age of patients with ATSCI above T6 increased significantly over the 20-year period (49 vs. 51 vs. 57 years; P = 0.046), as did their Charlson Comorbidity Index (CCI).
  • 2
    Falls became the most frequent cause of injury, increasing from 30% to 47% over the study period.
  • 3
    The length of stay in the ICU decreased significantly over the years (30 ± 19 vs. 22 ± 14 vs. 19 ± 13 days), despite the increasing age and comorbidity of patients.

Research Summary

This retrospective study analyzed data from 241 patients with ATSCI above T6 admitted to a Spanish ICU between 1998 and 2017. The study aimed to identify trends in patient demographics, injury characteristics, and their impact on ICU resource utilization, length of stay, and mortality. The results indicated a significant increase in the age and comorbidity of patients with ATSCI above T6, with falls becoming the predominant cause of injury. Despite these changes, the length of stay in the ICU decreased significantly over the study period. The study concludes that while the profile of patients with ATSCI above T6 is changing, with an increasing number of older patients with more comorbidities, the length of ICU stay has decreased without a corresponding increase in mortality rates.

Practical Implications

Resource Allocation

Healthcare providers and hospitals should adapt their resource allocation to accommodate the increasing number of older patients with comorbidities who sustain ATSCI above T6.

Prevention Programs

Public health initiatives should focus on preventing falls, particularly among the elderly, to reduce the incidence of ATSCI.

Treatment Strategies

ICU protocols should be optimized to manage older patients with complex medical needs, aiming to reduce the length of stay without compromising mortality rates.

Study Limitations

  • 1
    Single-center study may limit generalizability.
  • 2
    Retrospective nature may introduce information bias.
  • 3
    Lack of regional registry may have affected the inclusion of patients.

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