title: The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review.
abstract: Current recommendations for traumatic spinal cord injury treatment recommend immediate transfer to a spinal injury unit (SIU) where available following patient stabilisation. Although transfer is dependent on a variety of factors, the largest review was unable to justify implementation of such units on the basis of insufficient and lack of quality data in favour of care at the SIU as opposed to non-SIU centres. Our study sought to investigate: are subspecialty spinal injury units (SIUs) able to provide superior care compared with traditional trauma/rehab units? Is the standard of care of acute spinal cord injured patients to be managed in SIU's?
  
  
  
  A literature search was conducted across five major databases using the key terms: "spinal cord injury" AND "Spinal Injury Unit" OR "spinal rehabilitation" OR "spinal injury centre" OR "specialist care" OR "care requirements."
  
  
  
  After review of over 500 studies, only 9 met inclusion criteria, 3 of which were past reviews. There were no relevant RCT's obtained. Standardised roles of global SIU units are needed to deliver equitable and high quality care as current evidence demonstrates variable standards of care and service (mean LOS range: 16-174 days). There is low quality evidence supporting earlier admission into SIU units being associated with improved neurological outcome, complication rates and reduced LOS, despite variations in the definition of "early admission" across studies.
  
  
  
  Our review demonstrates a lack of standardisation within SIU on a global scale, with significantly different outcomes reported across published studies. New and higher quality evidence directly comparing SIU to non-SIU based care is required. Earlier transfer (<24 h) to SIU following initial injury and stabilisation is advised.
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. monish.maharaj@gmail.com.|NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, NSW, 2031, Australia. monish.maharaj@gmail.com.|NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia. monish.maharaj@gmail.com.
authors.forename: Monish M
authors.initials: MM
authors.lastname: Maharaj
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.|NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, NSW, 2031, Australia.|NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia.
authors.forename: Jarred A
authors.initials: JA
authors.lastname: Hogan
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.|NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, NSW, 2031, Australia.|NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.|NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, NSW, 2031, Australia.|NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D003695:Delivery of Health Care; D006760:Hospitalization; D006801:Humans; D011787:Quality of Health Care; D013119:Spinal Cord Injuries / Q000628:therapy*; D014193:Trauma Centers
keywords: Specialist care; Spinal cord injury; Spinal injury centre; Spinal injury unit; Spinal rehabilitation; Trauma