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  • Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery

    Author(s)
    Battistuzzo, Camila R
    Armstrong, Alex
    Clark, Jillian
    Worley, Laura
    Sharwood, Lisa
    Lin, Peny
    Rooke, Gareth
    Skeers, Peta
    Nolan, Sherilyn
    Geraghty, Timothy
    Nunn, Andrew
    Brown, Doug J
    Hill, Steven
    Atresh, Sridhar
    et al.
    Griffith University Author(s)
    Atresh, Sridhar
    Year published
    2016
    Metadata
    Show full item record
    Abstract
    Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times ...
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    Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.
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    Journal Title
    Journal of Neurotrauma
    Volume
    33
    Issue
    12
    DOI
    https://doi.org/10.1089/neu.2015.4207
    Subject
    Clinical sciences
    Neurosciences
    Science & Technology
    Life Sciences & Biomedicine
    Critical Care Medicine
    Clinical Neurology
    Neurosciences
    Publication URI
    http://hdl.handle.net/10072/406601
    Collection
    • Journal articles

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