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Impact of Specialized Versus Non-Specialized Acute Hospital Care on Survival Among Patients With Acute Incomplete Traumatic Spinal Cord Injuries: A Population-Based Observational Study from British Columbia, Canada.
Dvorak, Marcel F; Evaniew, Nathan; Chen, Melody; Waheed, Zeina; Rotem-Kohavi, Naama; Fallah, Nader; Noonan, Vanessa K; Fisher, Charles; Charest-Morin, Raphaële; Dea, Nicolas; Ailon, Tamir; Street, John; Kwon, Brian K.
Afiliación
  • Dvorak MF; Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
  • Evaniew N; International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.
  • Chen M; University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada.
  • Waheed Z; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
  • Rotem-Kohavi N; Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
  • Fallah N; Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
  • Noonan VK; Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
  • Fisher C; Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
  • Charest-Morin R; Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
  • Dea N; Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
  • Ailon T; Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
  • Street J; Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
  • Kwon BK; Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada.
J Neurotrauma ; 40(23-24): 2638-2647, 2023 12.
Article en En | MEDLINE | ID: mdl-37294210
Given the complexity of care necessitated after an acute traumatic spinal cord injury (SCI), it seems intuitively beneficial for such care to be delivered at hospitals with specialized SCI expertise. Demonstrating these benefits is not straightforward, however. We sought to determine whether specialized acute hospital care influenced the most fundamental outcomes after SCI: mortality within the first year of injury. We compared survival among patients with incomplete tSCI admitted to a single quaternary-level trauma hospital with a specialized acute SCI program versus those admitted to trauma hospitals without specialized acute SCI care. We performed a population-based retrospective observational cohort study using administrative and clinical data linked from multiple sources in British Columbia (BC) from 2001 to 2017. Among a cohort of 1920 patients, there were 193 deaths within one year. We failed to identify a significant overall benefit for survival after adjusting for potential confounders, and the confidence intervals (CIs) were compatible with both benefit and harm (odds ratio [OR] 1.01, 95% CI 0.17 to 6.11, p = 0.99). Significant associations were observed with age greater than 65 (OR 4.92, 95% CI 1.66 to 14.57, p < 0.01), Charlson Comorbidity Index (OR 1.61, 95% CI 1.42 to 1.83, p < 0.01), Injury Severity Score (OR 1.08, 95% CI 1.06 to 1.11, p < 0.01), and traumatic brain injury (OR 2.12, 95% CI 1.32 to 3.41, p < 0.01). Among patients with acute tSCI, admission to a hospital with specialized acute SCI care was not associated with improved overall one-year survival. Subgroup analyses, however, suggested heterogeneity of effects, with little benefit for older patients with less polytrauma and substantial benefit for younger patients with greater polytrauma.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Traumatismo Múltiple Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Neurotrauma Asunto de la revista: NEUROLOGIA / TRAUMATOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Imprimir
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Traumatismo Múltiple Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Neurotrauma Asunto de la revista: NEUROLOGIA / TRAUMATOLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos