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Regionalization of Spine Trauma Care in an Urban Trauma System in the United States: Decreased Time to Surgery and Hospital Length of Stay.
Kelly, Michael L; He, Jack; Roach, Mary Jo; Moore, Timothy A; Steinmetz, Michael P; Claridge, Jeffrey A.
Afiliación
  • Kelly ML; Department of Neurosurgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
  • He J; Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
  • Roach MJ; Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
  • Moore TA; Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
  • Steinmetz MP; Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
  • Claridge JA; Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
Neurosurgery ; 85(6): 773-778, 2019 12 01.
Article en En | MEDLINE | ID: mdl-30329091
BACKGROUND: The effect of regionalized trauma care (RT) on hospital-based outcomes for traumatic spine injury (TSI) in the United States is unknown. OBJECTIVE: To test the hypothesis that RT would be associated with earlier time to surgery and decreased length of stay (LOS). METHODS: TSI patients >14 yr were identified using International Classification of Diseases Ninth Revision Clinical Modification diagnostic codes. Data from 2008 through 2012 were analyzed before and after RT in 2010. RESULTS: A total of 4072 patients were identified; 1904 (47%) pre-RT and 2168 (53%) post-RT. Injury severity scores, Spine Abbreviated Injury Scale scores, and the percentage of TSIs with spinal cord injury (tSCI) were similar between time periods. Post-RT TSIs demonstrated a lower median intensive care unit (ICU) LOS (0 vs 1 d; P < 0.0001), underwent spine surgery more frequently (13% vs 11%; P = 0.01), and had a higher rate of spine surgery performed within 24 h of admission (65% vs 55%; P = 0.02). In patients with tSCI post-RT, ICU LOS was decreased (1 vs 2 d; P < 0.0001) and ventilator days were reduced (average days: 2 vs 3; P = 0.006). The post-RT time period was an independent predictor for spine surgery performed in less than 24 h for all TSIs (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.04-2.22, C-stat = 0.65). Multivariate linear regression analysis demonstrated an independent effect on reduced ICU LOS post-RT for TSIs (OR -1.68; 95% CI: -2.98 to 0.39; R2 = 0.74) and tSCIs (OR -2.42, 95% CI: -3.99-0.85; R2 = 0.72). CONCLUSION: RT is associated with increased surgical rates, earlier time to surgery, and decreased ICU LOS for patients with TSI.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Hospitales Urbanos / Puntaje de Gravedad del Traumatismo / Tiempo de Tratamiento / Tiempo de Internación Tipo de estudio: Observational_studies / Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neurosurgery Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Hospitales Urbanos / Puntaje de Gravedad del Traumatismo / Tiempo de Tratamiento / Tiempo de Internación Tipo de estudio: Observational_studies / Prognostic_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Neurosurgery Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos