title: Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery.
abstract: Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), the University of Melbourne , Melbourne, Australia .
authors.forename: Camila R
authors.initials: CR
authors.lastname: Battistuzzo
authors.affiliation: 2 School of Animal Biology, the University of Western Australia , Perth Australia .
authors.forename: Alex
authors.initials: A
authors.lastname: Armstrong
authors.affiliation: 3 Center for Orthopedic and Trauma Research, the University of Adelaide , Adelaide, Australia .
authors.forename: Jillian
authors.initials: J
authors.lastname: Clark
authors.affiliation: 4 Queensland Spinal Injuries Service, Princess Alexandra Hospital , Woolloongabba, Australia .
authors.forename: Laura
authors.initials: L
authors.lastname: Worley
authors.affiliation: 5 John Walsh Center for Rehabilitation Research, the University of Sydney , Sydney, Australia .
authors.forename: Lisa
authors.initials: L
authors.lastname: Sharwood
authors.affiliation: 6 Orthopedic Department, Middlemore Hospital , Auckland, New Zealand .
authors.forename: Peny
authors.initials: P
authors.lastname: Lin
authors.affiliation: 7 Orthopedic Department, Christchurch Hospital , Christchurch, New Zealand .
authors.forename: Gareth
authors.initials: G
authors.lastname: Rooke
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), the University of Melbourne , Melbourne, Australia .
authors.forename: Peta
authors.initials: P
authors.lastname: Skeers
authors.affiliation: 2 School of Animal Biology, the University of Western Australia , Perth Australia .
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Nolan
authors.affiliation: 4 Queensland Spinal Injuries Service, Princess Alexandra Hospital , Woolloongabba, Australia .
authors.forename: Timothy
authors.initials: T
authors.lastname: Geraghty
authors.affiliation: 8 Victorian Spinal Cord Service, Austin Hospital , Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nunn
authors.affiliation: 9 The Spinal Research Institute , Melbourne, Australia .
authors.forename: Doug J
authors.initials: DJ
authors.lastname: Brown
authors.affiliation: 8 Victorian Spinal Cord Service, Austin Hospital , Melbourne, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Hill
authors.affiliation: 8 Victorian Spinal Cord Service, Austin Hospital , Melbourne, Australia.
authors.forename: Janette
authors.initials: J
authors.lastname: Alexander
authors.affiliation: 8 Victorian Spinal Cord Service, Austin Hospital , Melbourne, Australia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Millard
authors.affiliation: 10 Neuroscience Trials Australia, the Florey Institute of Neuroscience , Melbourne, Australia .
authors.forename: Susan F
authors.initials: SF
authors.lastname: Cox
authors.affiliation: 11 Trauma Service, Royal Perth Hospital , Perth, Australia .
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Rao
authors.affiliation: 12 Spinal Unit, Royal Perth Hospital , Perth, Australia .
authors.forename: Ann
authors.initials: A
authors.lastname: Watts
authors.affiliation: 2 School of Animal Biology, the University of Western Australia , Perth Australia .
authors.forename: Louise
authors.initials: L
authors.lastname: Goods
authors.affiliation: 13 School of Physiotherapy and Exercise Science, Curtin University , Bentley, Australia .
authors.forename: Garry T
authors.initials: GT
authors.lastname: Allison
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), the University of Melbourne , Melbourne, Australia .
authors.forename: Jacqui
authors.initials: J
authors.lastname: Agostinello
authors.affiliation: 14 Emergency and Trauma Center, the Alfred Hospital , Melbourne, Australia .
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: 15 College of Science, Health and Engineering, La Trobe University , Melbourne, Australia .
authors.forename: Ian
authors.initials: I
authors.lastname: Mosley
authors.affiliation: 16 Department of Orthopedic Surgery, the Alfred Hospital , Melbourne, Australia .
authors.forename: Susan M
authors.initials: SM
authors.lastname: Liew
authors.affiliation: 6 Orthopedic Department, Middlemore Hospital , Auckland, New Zealand .
authors.forename: Tom
authors.initials: T
authors.lastname: Geddes
authors.affiliation: 5 John Walsh Center for Rehabilitation Research, the University of Sydney , Sydney, Australia .
authors.forename: James
authors.initials: J
authors.lastname: Middleton
authors.affiliation: 17 Department of Physiotherapy, Royal Perth Hospital , Perth, Australia .
authors.forename: John
authors.initials: J
authors.lastname: Buchanan
authors.affiliation: 18 Department of Neurosurgery, the Alfred Hospital , Melbourne, Australia .
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
authors.affiliation: 19 Intensive Care Unit, the Alfred Hospital , Melbourne, Australia .
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: 4 Queensland Spinal Injuries Service, Princess Alexandra Hospital , Woolloongabba, Australia .
authors.forename: Sridhar
authors.initials: S
authors.lastname: Atresh
authors.affiliation: 6 Orthopedic Department, Middlemore Hospital , Auckland, New Zealand .
authors.forename: Alpesh
authors.initials: A
authors.lastname: Patel
authors.affiliation: 7 Orthopedic Department, Christchurch Hospital , Christchurch, New Zealand .
authors.forename: Rowan
authors.initials: R
authors.lastname: Schouten
authors.affiliation: 20 Department of Orthopedics and Trauma, the University of Adelaide , Adelaide, Australia .
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
authors.affiliation: 2 School of Animal Biology, the University of Western Australia , Perth Australia .
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Dunlop
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), the University of Melbourne , Melbourne, Australia .
authors.forename: Peter E
authors.initials: PE
authors.lastname: Batchelor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D066193:Cervical Cord / Q000293:injuries* / Q000601:surgery*; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000601:surgery*; D055815:Young Adult
keywords: decompression; process of care; spinal cord injury; spine surgery