Medicina de Emergência: Acesso Aberto
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Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord Injury

Sharwood LN, Boufous S, Muecke S and Middleton JW

Background: Addressing policy change in traumatic injury care demands a strong evidence base from which to inform necessary amendments, and measure the impact of any change. Current recommendations for acute traumatic spinal cord injury include admission to a specialist Spinal Cord Injury Unit within 24 hours from injury. This study aimed to document pathways for patients with traumatic spinal cord injury across a state-wide Health Service in a historical cohort, prior to and in order to inform trauma policy changes. Methods: Retrospective analysis of a large Ambulance service record-linked dataset, containing 2.04 million Ambulance records linked with hospital and death records (2006-09). Incident cases of traumatic spinal cord injury were identified using ICD-10-AM codes. Multivariate analysis aimed to identify factors associated with admission to specialist units within 24 hours. Results: Of 311 patients with confirmed traumatic spinal cord injury, 177 (56.9%) were admitted to a specialist Spinal Cord Injury Unit, with 130 of these (73.4%) being within 24 hours post injury. The remaining 47 (26.6%) had up to several months delayed transfer to SCIU. Patients were significantly more likely to have timely admission to SCIU with a cervical level cord injury (OR 2.05), aeromedical transfer to a specialist unit (OR 2.5), outer regional geographic location of injury (OR 2.05), or a surgical spinal procedure within 24 hours (OR 3.1). Patients were significantly less likely to be admitted to a specialist unit within 24 hours were those who experienced more than one hospital transfer (OR 0.28), and patients >75 years (OR 0.35). Conclusion: Historically across this state-wide Health Service, patients with traumatic spinal cord injury did not experience consistent treatment pathways. Publication of this study importantly provides a baseline from which changes to clinical policies that have occurred since 2009 can be evaluated.