title: Evaluating initial spine trauma response: injury time to trauma center in PA, USA.
abstract: Historical perceptions regarding the severity of traumatic spinal cord injury has led to considerable disparity in triage to tertiary care centers. This article retrospectively reviews a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns. The Pennsylvania Trauma database was retrospectively reviewed. All acute trauma patient entries for level I and II centers were categorized for diagnosis, mechanism, and location of injury, analyzing transportation modality and its influence on time of arrival. A total of 1162 trauma patients were identified (1014 blunt injuries, 135 penetrating injuries and 12 other) with a mean transport time of 3.9 hours and a majority of patients arriving within 7 hours (>75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours), and penetrating injuries (2.13 hours, p<0.0001). There was a statistically significant correlation between earlier arrivals and both cranial trauma (p=0.0085) and penetrating trauma (p<0.0001). The fastest modality was a fire rescue (0.93 hours) or police (0.63 hours) vehicle with Philadelphia County (1.1 hour) having the quickest arrival times. Most trauma patients arrived to a specialty center within 7 hours of injury. However subsets analysis revealed that spine trauma patients had the greatest transit times. Present research trials for spinal cord injuries suggest earlier intervention may lead to improved recovery. Therefore, it is important to focus on improvement of the transportation triage system for traumatic spinal patients.
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA. Electronic address: james.harrop@jefferson.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Chitale
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Krespan
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Odorizzi
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Tristan
authors.initials: T
authors.lastname: Fried
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Murray
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Vaccaro
mesh_terms: D016208:Databases, Factual; D006801:Humans; D010414:Pennsylvania; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data*
keywords: Cranial; Epidemiology; Neurologic; SCI; Transportation; Trauma; Triage