title: Spinal injuries centres (SICs) for acute traumatic spinal cord injury.
abstract: BACKGROUND
  The majority of complications in traumatic spinal cord injury (SCI) can occur in the first 24 hours and it has been suggested that spinal injury centres (SICs) may influence the pre-transfer care of people with SCI. The specialist SIC concept has been adopted in a number of high-income countries. However, even in such countries, a potentially significant number of people with SCI do not have the opportunity to access this system and are managed in a non-specialist environment.
  
  
  OBJECTIVE
  To answer the question: does immediate referral to an SIC result in a better outcome than delayed referral?
  
  
  METHODS
  The following databases were searched: AMED, CCTR, CINAHL, DARE, EMBASE, HEED, HMIC, MEDLINE, NRR, NHS EED, and PsycLIT. Searches were updated in May 2003 and included the Cochrane Injuries Group Specialist Register. The reference lists of retrieved articles were checked.
  
  
  METHODS
  Randomised controlled trials and controlled trials that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI.
  
  
  METHODS
  Two reviewers independently selected studies. One reviewer was to have assessed the quality of the studies and extracted data.
  
  
  RESULTS
  No randomised controlled trials or controlled trials were identified that compared immediate referral to an SIC with delayed referral in patients with a traumatic SCI. All of the studies identified were retrospective observational studies and of poor quality.
  
  
  CONCLUSIONS
  The current evidence does not enable conclusions to be drawn about the benefits or disadvantages of immediate referral versus late referral to SICs. Well-designed, prospective experimental studies with appropriately matched controls are needed.
authors.affiliation: Department of Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK. l.jones@sheffield.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: Bagnall
mesh_terms: D006782:Hospitals, Special; D006801:Humans; D012017:Referral and Consultation; D013119:Spinal Cord Injuries / Q000628:therapy*; D013997:Time Factors