Evolution of Real-World Clinical Practice in Time to Surgery Following Thoracolumbar Spinal Cord Injury: An Observational Study of North American Trauma Centers from 2010 to 2020.

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Ahmad Essa, Armaan K Malhotra, Husain Shakil, Jetan Badhiwala, Avery B Nathens, Eva Y Yuan, Yingshi He, Andrew S Jack, Francois Mathieu, Jefferson R Wilson, Christopher D Witiw
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Abstract

This study aims to estimate real-world clinical practice trends in time to surgery following thoracolumbar spinal cord injury (SCI) in trauma centers across North America over the last decade (2010-2020). A multi-center retrospective observational study was conducted using Trauma Quality Improvement Program data from 2010 to 2020. All surgically treated patients with thoracic and lumbar SCI were included. Descriptive plots and a multivariable Poisson regression model with time to spine surgery as the primary outcome were constructed. This study included 4350 adult patients with complete SCI surgically treated across 449 trauma centers. Within this group, 3978 (91.4%) patients were diagnosed with thoracic SCI and 372 (8.6%) patients were diagnosed with lumbar SCI. The overall mean time to surgery was 31.6 h (±34.1). Early surgery (≤24 h) was performed in 2599 patients (59.7%). An estimated annual reduction of 1.6 h in time to surgery was demonstrated over the study period, starting initially at a mean of 47.6 h (±40.6) in 2010, and reaching a mean of 25.3 h (±30) in 2020. Multivariable Poisson regression adjusting for patient, injury, and institution confounders, demonstrated a significant decrease in time to surgery by 5% per year over the study period (incidence rate ratios [IRR] = 0.95, 95% confidence interval [CI]: 0.93-0.96). Moreover, in a secondary analysis including 3270 patients with incomplete thoracolumbar SCI, a comparable significant annual reduction in time to surgery was demonstrated (IRR = 0.93, 95% CI: 0.91-0.94). This study provides real-world data on practice pattern trends with respect to time to spine surgery following traumatic thoracolumbar SCI. Over the years from 2010 to 2020, we found a significant reduction in time to surgery across trauma centers in North America.

胸腰椎脊髓损伤后手术时间的真实世界临床实践演变:2010年至2020年北美创伤中心观察研究》。
本研究旨在估算过去十年(2010-2020 年)北美地区创伤中心胸腰椎脊髓损伤 (SCI) 手术时间的实际临床实践趋势。我们利用 2010 年至 2020 年的创伤质量改进计划数据开展了一项多中心回顾性观察研究。研究纳入了所有接受过手术治疗的胸椎和腰椎 SCI 患者。研究人员绘制了描述性曲线图,并建立了以脊柱手术时间为主要结果的多变量泊松回归模型。该研究共纳入了4350名在449个创伤中心接受手术治疗的完全性SCI成年患者。其中,3978 例(91.4%)患者被诊断为胸椎 SCI,372 例(8.6%)患者被诊断为腰椎 SCI。手术总平均时间为 31.6 小时(±34.1)。2599名患者(59.7%)接受了早期手术(≤24小时)。在研究期间,手术时间估计每年缩短1.6小时,从2010年的平均47.6小时(±40.6)开始,到2020年达到平均25.3小时(±30)。多变量泊松回归调整了患者、损伤和机构等混杂因素,结果表明,在研究期间,手术时间每年显著缩短 5%(发病率比 [IRR] = 0.95,95% 置信区间 [CI]:0.93-0.96)。此外,在一项包括 3270 名不完全胸腰椎 SCI 患者的二次分析中,结果显示手术时间每年也有类似的显著缩短(IRR = 0.93,95% 置信区间 [CI]:0.91-0.94)。本研究提供了创伤性胸腰椎 SCI 后脊柱手术时间实践模式趋势的真实数据。我们发现,从 2010 年到 2020 年,北美各创伤中心的手术时间显著缩短。
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来源期刊
Journal of neurotrauma
Journal of neurotrauma 医学-临床神经学
CiteScore
9.20
自引率
7.10%
发文量
233
审稿时长
3 months
期刊介绍: Journal of Neurotrauma is the flagship, peer-reviewed publication for reporting on the latest advances in both the clinical and laboratory investigation of traumatic brain and spinal cord injury. The Journal focuses on the basic pathobiology of injury to the central nervous system, while considering preclinical and clinical trials targeted at improving both the early management and long-term care and recovery of traumatically injured patients. This is the essential journal publishing cutting-edge basic and translational research in traumatically injured human and animal studies, with emphasis on neurodegenerative disease research linked to CNS trauma.
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