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Title: Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery.
Austin Authors: 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 ;Alexander, Janette;Millard, Melinda;Cox, Susan F;Rao, Sudhakar;Watts, Ann;Goods, Louise;Allison, Garry T;Agostinello, Jacqui;Cameron, Peter A;Mosley, Ian;Liew, Susan M;Geddes, Tom;Middleton, James;Buchanan, John;Rosenfeld, Jeffrey V;Bernard, Stephen;Atresh, Sridhar;Patel, Alpesh;Schouten, Rowan;Freeman, Brian J C;Dunlop, Sarah A;Batchelor, Peter E
Affiliation: Department of Medicine (Royal Melbourne Hospital), the University of Melbourne , Melbourne, Australia
School of Animal Biology, the University of Western Australia , Perth Australia
Center for Orthopedic and Trauma Research, the University of Adelaide , Adelaide, Australia
Queensland Spinal Injuries Service, Princess Alexandra Hospital , Woolloongabba, Australia
John Walsh Center for Rehabilitation Research, the University of Sydney , Sydney, Australia
Orthopedic Department, Middlemore Hospital , Auckland, New Zealand
Orthopedic Department, Christchurch Hospital , Christchurch, New Zealand
Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
The Spinal Research Institute , Melbourne, Australia
Neuroscience Trials Australia, the Florey Institute of Neuroscience , Melbourne, Australia
Trauma Service, Royal Perth Hospital , Perth, Australia
Spinal Unit, Royal Perth Hospital , Perth, Australia
School of Physiotherapy and Exercise Science, Curtin University , Bentley, Australia
Emergency and Trauma Center, the Alfred Hospital , Melbourne, Australia
College of Science, Health and Engineering, La Trobe University , Melbourne, Australia
Department of Orthopedic Surgery, the Alfred Hospital , Melbourne, Australia
Department of Physiotherapy, Royal Perth Hospital , Perth, Australia
Department of Neurosurgery, the Alfred Hospital , Melbourne, Australia
Intensive Care Unit, the Alfred Hospital , Melbourne, Australia
Department of Orthopedics and Trauma, the University of Adelaide , Adelaide, Australia
Issue Date: 15-Jun-2016 2016
Publication information: Journal of neurotrauma 2016; 33(12): 1161-1169
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 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.
DOI: 10.1089/neu.2015.4207
PubMed URL: 26650510
PubMed URL:
Type: Journal Article
Subjects: decompression
process of care
spinal cord injury
spine surgery
Appears in Collections:Journal articles

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