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
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