Emergency, acute, and surgical management of spine trauma.
OBJECTIVE
To assess trends in emergency, acute, and surgical management of spinal cord injury (SCI), and evaluate the relations between surgery and the occurrence of specific complications.


METHODS
Model SCI Care Systems.


METHODS
Case series.


METHODS
Consecutive samples of 3,756 acute spinal injuries admitted to the Midwest Regional Spinal Cord Injury Care System between 1990 and 1999, 2,204 individuals admitted to a Model SCI System within 24 hours of injury before 1995, and 941 individuals who were injured between December 1995 and August 1998 and were admitted to a Model System within 24 hours of injury.


METHODS
Frequencies of injury types, nonoperative treatment and types of spine surgeries, and time sequence associated complications including postoperative wound infections, pressure ulcers, deep vein thrombophlebitis, pulmonary embolism, and pneumonia or atelectasis.


RESULTS
Eighty-eight percent of cases entering a Model System through acute care were admitted within 72 hours of injury, 85% were admitted within 24 hours. Comparing 1990 with 1998, the number of persons admitted to Model Systems within 72 hours of injury declined 11%. Operative treatment within the Model Systems increased 5% (p < .01), with increases due to decompression surgeries. Complication rates of nonoperative and surgical cases were not different.


CONCLUSIONS
The reduction in 72-hour admissions suggests an increasing percentage of admissions are directly to rehabilitation at a Model System after receiving acute care elsewhere. The increase in the use of surgical procedures involving surgical decompression of the spine is probably due to advances in surgical technology and increased experience and confidence in spine surgery. Surgery does not influence complication development beyond the usual expectations for those who sustain SCI.
Waters
R L
RL
Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA.
Meyer
P R
PR
Adkins
R H
RH
Felton
D
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000639:trends*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D003668:Pressure Ulcer / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000209:etiology; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D013119:Spinal Cord Injuries / Q000145:classification / Q000209:etiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000145:classification; D014481:United States / Q000453:epidemiology