In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Evaluating Initial Spine Trauma Response: Injury Time to Trauma Center

    Final Number:
    1172

    Authors:
    Rohan Chitale MD; Alexander R. Vaccaro MD; James S. Harrop MD, FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Recent evidence supports that outcomes for spine trauma patients may be time sensitive. However, unlike penetrating injuries where there is an overall recognition of the need for emergent and rapid transportation, there is a perception that spinal trauma does not require emergent, but only urgent, triage to specialty centers. We retrospectively review a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns.

    Methods: The Pennsylvania Trauma Systems Foundation’s State Registry, Pennsylvania Trauma Outcome Study (PTOS), was retrospectively reviewed over a one year period (1/1-12/31/10). All acute trauma patients’ entries were categorized by mechanism of injury into blunt or penetrating traumas. These were further categorized into: spine trauma, cranial/closed head injuries and other injuries. The influence of transportation modality on arrival time was performed. A separate analysis of arrival time based on county of origin of the injury and county where patient was admitted was performed with respect to each injury type.

    Results: 1162 patients were included in the analysis. Mean transport time was 3.9 hours with the majority of patients arriving within seven hours (>75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours) and penetrating injuries (2.13 hours, p<0.0001). There was a statistically significant correlation between earlier arrivals and both cranial trauma (p=0.0085) and penetrating trauma (p<0.0001). The fastest modality was fire-rescue (0.93hrs) or police (0.63hrs) vehicle.

    Conclusions: While most trauma patients arrived to a specialty center within 7 hours of injury, spine trauma patients had the greatest transit times. Present research trials for spinal cord injuries suggest earlier intervention may lead to improved recovery. Therefore, it is important to focus on improvement of the transportation triage system for spine trauma patients.

    Patient Care: Evaulating transportation systems for trauma patients will allow for improved efficiency in transfer of spine trauma patients and help improve patient outcomes.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)describe the importance of timing in spine trauma outcomes, 2) discuss, in small groups, the need for effective triage systems for trauma patients, 3) identify ways to improve regional triage systems

    References: [1] Fehlings MG, Vaccaro A, Wilson JR, Singh A, D WC, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PloS one.7(2):e32037. [2] Tariq UM, Faruque A, Ansari H, Ahmad M, Rashid U, Perveen S, et al. Changes in the patterns, presentation and management of penetrating chest trauma patients at a level II trauma centre in southern Pakistan over the last two decades. Interact Cardiovasc Thorac Surg. 2011 Jan;12(1):24-7. [3] Gervin AS, Fischer RP. The importance of prompt transport of salvage of patients with penetrating heart wounds. J Trauma. 1982 Jun;22(6):443-8. [4] Aguero-Valverde J, Jovanis PP. Spatial analysis of fatal and injury crashes in Pennsylvania. Accident; analysis and prevention. 2006 May;38(3):618-25. [5] Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, et al. Access to trauma centers in the United States. JAMA : the journal of the American Medical Association. 2005 Jun 1;293(21):2626-33. [6] Hartl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. The Journal of trauma. 2006 Jun;60(6):1250-6; discussion 6. [7] Petri RW, Dyer A, Lumpkin J. The effect of prehospital transport time on the mortality from traumatic injury. Prehospital and disaster medicine. 1995 Jan-Mar;10(1):24-9. [8] Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D. Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. The Journal of trauma. 1997 Aug;43(2):288-95; discussion 95-6. [9] Kelly DF, Becker DP. Advances in management of neurosurgical trauma: USA and Canada. World journal of surgery. 2001 Sep;25(9):1179-85. [10] Shackford SR, Mackersie RC, Hoyt DB, Baxt WG, Eastman AB, Hammill FN, et al. Impact of a trauma system on outcome of severely injured patients. Arch Surg. 1987 May;122(5):523-7. [11] Klauber MR, Marshall LF, Toole BM, Knowlton SL, Bowers SA. Cause of decline in head-injury mortality rate in San Diego County, California. Journal of neurosurgery. 1985 Apr;62(4):528-31. [12] Colohan AR, Alves WM, Gross CR, Torner JC, Mehta VS, Tandon PN, et al. Head injury mortality in two centers with different emergency medical services and intensive care. Journal of neurosurgery. 1989 Aug;71(2):202-7. [13] Lind CR, Heppner PA, Robins TM, Mee EW. Transfer of intubated patients with traumatic brain injury to Auckland City Hospital. ANZ J Surg. 2005 Oct;75(10):858-62. [14] Sampalis JS, Denis R, Lavoie A, Frechette P, Boukas S, Nikolis A, et al. Trauma care regionalization: a process-outcome evaluation. The Journal of trauma. 1999 Apr;46(4):565-79; discussion 79-81. [15] Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. Journal of neurotrauma. 2011 Aug;28(8):1371-99. [16] Lokkeberg AR, Grimes RM. Assessing the influence of non-treatment variables in a study of outcome from severe head injuries. Journal of neurosurgery. 1984 Aug;61(2):254-62. [17] Fehlings MG, Wilson JR. Timing of surgical intervention in spinal trauma: what does the evidence indicate? Spine. Oct 1;35(21 Suppl):S159-60. [18] Sonmez E, Kabatas S, Ozen O, Karabay G, Turkoglu S, Ogus E, et al. Minocycline Treatment Inhibits Lipid Peroxidation, Preserves Spinal Cord Ultrastructure and Improves Functional Outcome after Traumatic Spinal Cord Injury in the Rat. Spine. Jan 30. [19] Wilson JR, Fehlings MG. Riluzole for Acute Traumatic Spinal Cord Injury: A Promising Neuroprotective Treatment Strategy. World neurosurgery. Jan 4. [20] Furlan JC, Tung K, Fehlings M. Process Benchmarking Appraisal of Early Surgical Decompression of Spinal Cord following Traumatic Cervical Spinal Cord Injury: Opportunities to Enhance the Time to Definitive Treatment. Journal of neurotrauma. Oct 22.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy