Menco J S Niemeyer1, R D Lokerman1, S Sadiqi2, M van Heijl3, R M Houwert1, K J P van Wessem1, M W M Post4,5, C F van Koppenhagen6. 1. University Medical Center Utrecht, Department of Trauma Surgery, Utrecht, the Netherlands. 2. University Medical Center Utrecht, Department of Orthopedics, Utrecht, the Netherlands. 3. Diakonessenhuis Hospital, Department of Surgery, Utrecht, the Netherlands. 4. University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands. 5. University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sports, UMCU Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands. 6. University Medical Center Utrecht, Center of Excellence for Rehabilitation Medicine, UMCU Brain Center and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
Abstract
BACKGROUND: Evaluating treatment of traumatic spinal cord injuries (TSCIs) from the prehospital phase until postrehabilitation is crucial to improve outcomes of future TSCI patients. OBJECTIVE: To describe the flow of patients with TSCI through the prehospital, hospital, and rehabilitation settings and to relate treatment outcomes to emergency medical services (EMS) transport locations and surgery timing. METHOD: Consecutive TSCI admissions to a level I trauma center (L1TC) in the Netherlands between 2015 and 2018 were retrospectively identified. Corresponding EMS, hospital, and rehabilitation records were assessed. RESULTS: A total of 151 patients were included. Their median age was 58 (IQR 37-72) years, with the majority being male (68%) and suffering from cervical spine injuries (75%). In total, 66.2% of the patients with TSCI symptoms were transported directly to an L1TC, and 30.5% were secondarily transferred in from a lower level trauma center. Most injuries were due to falls (63.0%) and traffic accidents (31.1%), mainly bicycle-related. Most patients showed stable vital signs in the ambulance and the emergency department. After hospital discharge, 71 (47.0%) patients were admitted to a rehabilitation hospital, and 34 (22.5%) patients went home. The 30-day mortality rate was 13%. Patients receiving acute surgery (<12 hours) compared to subacute surgery (>12h, <2 weeks) showed no significance in functional independence scores after rehabilitation treatment. CONCLUSION: A surge in age and bicycle-injuries in TSCI patients was observed. A substantial number of patients with TSCI were undertriaged. Acute surgery (<12 hours) showed comparable outcomes results in subacute surgery (>12h, <2 weeks) patients.
BACKGROUND: Evaluating treatment of traumatic spinal cord injuries (TSCIs) from the prehospital phase until postrehabilitation is crucial to improve outcomes of future TSCI patients. OBJECTIVE: To describe the flow of patients with TSCI through the prehospital, hospital, and rehabilitation settings and to relate treatment outcomes to emergency medical services (EMS) transport locations and surgery timing. METHOD: Consecutive TSCI admissions to a level I trauma center (L1TC) in the Netherlands between 2015 and 2018 were retrospectively identified. Corresponding EMS, hospital, and rehabilitation records were assessed. RESULTS: A total of 151 patients were included. Their median age was 58 (IQR 37-72) years, with the majority being male (68%) and suffering from cervical spine injuries (75%). In total, 66.2% of the patients with TSCI symptoms were transported directly to an L1TC, and 30.5% were secondarily transferred in from a lower level trauma center. Most injuries were due to falls (63.0%) and traffic accidents (31.1%), mainly bicycle-related. Most patients showed stable vital signs in the ambulance and the emergency department. After hospital discharge, 71 (47.0%) patients were admitted to a rehabilitation hospital, and 34 (22.5%) patients went home. The 30-day mortality rate was 13%. Patients receiving acute surgery (<12 hours) compared to subacute surgery (>12h, <2 weeks) showed no significance in functional independence scores after rehabilitation treatment. CONCLUSION: A surge in age and bicycle-injuries in TSCI patients was observed. A substantial number of patients with TSCI were undertriaged. Acute surgery (<12 hours) showed comparable outcomes results in subacute surgery (>12h, <2 weeks) patients.
Authors: Jan P Vandenbroucke; Erik von Elm; Douglas G Altman; Peter C Gøtzsche; Cynthia D Mulrow; Stuart J Pocock; Charles Poole; James J Schlesselman; Matthias Egger Journal: Epidemiology Date: 2007-11 Impact factor: 4.822
Authors: Quirine M J van der Vliet; Oscar E C van Maarseveen; Diederik P J Smeeing; Roderick M Houwert; Karlijn J P van Wessem; Rogier K J Simmermacher; Geertje A M Govaert; Mirjam B de Jong; Ivar G J de Bruin; Luke P H Leenen; Falco Hietbrink Journal: Injury Date: 2018-08-10 Impact factor: 2.586
Authors: Shalini Selvarajah; Adil H Haider; Eric B Schneider; Cristina L Sadowsky; Daniel Becker; Edward R Hammond Journal: J Neurotrauma Date: 2015-09-09 Impact factor: 5.269
Authors: Alex A Aimetti; Steven Kirshblum; Armin Curt; Joseph Mobley; Robert G Grossman; James D Guest Journal: Spinal Cord Date: 2019-06-10 Impact factor: 2.772
Authors: Livia E V M de Guerre; Said Sadiqi; Loek P H Leenen; Cumhur F Oner; Steven M van Gaalen Journal: Eur J Trauma Emerg Surg Date: 2018-10-15 Impact factor: 3.693
Authors: Marek Majdan; Dominika Plancikova; Eva Nemcovska; Lenka Krajcovicova; Alexandra Brazinova; Martin Rusnak Journal: Scand J Trauma Resusc Emerg Med Date: 2017-07-03 Impact factor: 2.953