title: Traumatic Spinal Cord Injury Emergency Service Triage Patterns and the Associated Emergency Department Outcomes.
abstract: Paralysis is an indication for trauma patients to be preferentially triaged by emergency services to designated level I or II trauma centers (TC). We sought to describe triage practices for patients with acute traumatic spinal cord injury (TSCI) and its associated emergency department (ED) outcomes. Adults ages ≥ 18 years with a diagnosis of acute TSCI (International Classification of Diseases-9: 806 and 952) in the 2006-2011 United States Nationwide Emergency Department Sample were included in these analyses. Outcomes assessed include triage to non-trauma centers (NTC), which is referred to as "under-triage," and ED mortality. Of 117,444 adults with TSCI, 33.4% were under-triaged to NTC. Under-triage was more prevalent with increasing age. Among patients under-triaged to NTC, 37.4% had new injury severity score (NISS) >15, representing severe injuries or polytrauma. Among patients with NISS >15, the odds of ED mortality in NTC were four-fold greater compared to level I trauma centers (TC-I) (adjusted odds ratio [AOR] = 4.06; 95% confidence interval = 1.87-8.79; p < 0.001). In conclusion, under-triage of adults with acute TSCI occurred in at least one-third of the cases. Patients triaged to NTC rather than TC-I experienced higher likelihood of death in the ED even after controlling for personal and injury characteristics. Further research is necessary to elucidate detailed clinical and logistical factors that may be associated with under-triage of acute TSCI, to facilitate interventions aimed at improving patient experience and outcomes.
authors.affiliation: 1 Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine , Baltimore, Maryland.|2 International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute , Baltimore, Maryland.
authors.forename: Shalini
authors.initials: S
authors.lastname: Selvarajah
authors.affiliation: 1 Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine , Baltimore, Maryland.|3 Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: 1 Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: 2 International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute , Baltimore, Maryland.
authors.forename: Cristina L
authors.initials: CL
authors.lastname: Sadowsky
authors.affiliation: 4 Department of Neurology, Johns Hopkins Hospital , Baltimore, Maryland.|5 International Neurorehabilitation Institute , Lutherville, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Becker
authors.affiliation: 2 International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger Institute , Baltimore, Maryland.|6 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Hammond
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D014193:Trauma Centers / Q000639:trends*; D016896:Treatment Outcome; D014218:Triage / Q000379:methods / Q000639:trends*; D014481:United States / Q000453:epidemiology
keywords: Nationwide Emergency Department Sample; spinal cord injury; triage, trauma center, outcomes