title: Spinal injuries admitted to a specialist centre over a 5-year period: a study to evaluate delayed admission.
abstract: METHODS
  Retrospective study of 432 patients admitted to our institution with a spinal injury over a 5-year period.
  
  
  OBJECTIVE
  To present epidemiological data relating to this spinal population, reporting specifically on delayed admission and length of hospitalisation.
  
  
  METHODS
  Royal National Orthopaedic Hospital, Stanmore, UK.
  
  
  METHODS
  A total of 432 traumatic spinal injuries admitted between March 1998 and March 2003 were analysed with respect to age, gender, mechanism of injury, level of bony injury, neurological level (complete, incomplete and intact), Injury Severity Score (ISS), date of injury, referral and admission independently and length of hospitalisation. The delays between injury and referral (>3 days) and between referral and admission (>7 days) were correlated to the length of hospitalisation. A detailed analysis of the cause of delay at both junctures was undertaken.
  
  
  RESULTS
  There were 322 males (average age, 38.6 years) and 110 females (average age, 41.8 years) in our study. Classification of neurological severity disclosed 108 complete injuries, 115 incomplete and 209 intact. The average time between injury and referral was 5.5 days (range 0-94), and between referral and admission was 10.7 days (range 0-130). A total of 161 patients (37%) experienced a delay between injury and referral, of whom 59 (37%) were subsequently also delayed to admission. The principal reason for delay between injury and referral was the treatment of concurrent injuries. Even patients with complete injuries (15/43) experienced delayed referral. In all, 112 patients (26%) experienced a delay between referral and admission. Principal reasons included the provision of beds (Intensive care, acute and rehabilitation) and physiological stabilisation of other injuries particularly thoracic trauma.
  
  
  CONCLUSIONS
  Provision of beds remains the most common preventable reason for delay between referral and admission and is associated with increased hospitalisation. Early liaison with a designated spinal injuries unit, particularly those with cord injury remains vitally important.
authors.affiliation: Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK.
authors.forename: A
authors.initials: A
authors.lastname: Amin
authors.forename: J
authors.initials: J
authors.lastname: Bernard
authors.forename: R
authors.initials: R
authors.lastname: Nadarajah
authors.forename: N
authors.initials: N
authors.lastname: Davies
authors.forename: F
authors.initials: F
authors.lastname: Gow
authors.forename: S
authors.initials: S
authors.lastname: Tucker
mesh_terms: D000328:Adult; D017677:Age Distribution; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014850:Waiting Lists