Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern.
Current research indicates that more than half of patients with traumatic spinal cord injury (tSCI) experience delays in transfer and receive surgery >24 h post-injury. The objectives of this study were to determine the geographic distribution of tSCI in Canada relative to specialized treatment facilities, to assess clinical and logistical factors at play for indirect admissions to those facilities, and to explore differences in current time to admission and simulated scenarios in an attempt to assess the potential impact of changes to triage protocols. This study included data from 876 patients with tSCI enrolled in the prospectively collected acute Rick Hansen Spinal Cord Injury Registry (RHSCIR) between January 1, 2010 and December 31, 2013 for whom there were data on the location of their injury. Patients transported directly to a RHSCIR acute facility were more likely to reach the facility within 1 h of injury, whereas those transported indirectly were more likely to arrive 7 h later. Considering the injuries occurring within 40 km of a RHSCIR acute facility (n= 323), 249 patients (77%) were directly and 74 (23%) were indirectly admitted. In the multivariate regression analysis, only older age and longer road distance remained significantly associated with being indirectly admitted to a RHSCIR facility. Compared with the current status, the median time to admission decreased by 20% (3.5 h) in the 100% direct admission scenario, and increased by 102% (8.9 h) in the 100% indirect admission scenario.
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Christiana L
CL
Cheng
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Vanessa K
VK
Noonan
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Jayson
J
Shurgold
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Jason
J
Chen
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Carly S
CS
Rivers
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Hamid
H
Khaleghi Hamedani
Rick Hansen Institute, Vancouver, British Columbia, Canada.
Suzanne
S
Humphreys
Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada.
Christopher S
CS
Bailey
Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada.
Najmedden
N
Attabib
Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Jean-Marc
JM
Mac Thiong
Sections of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Michael
M
Goytan
Sciences Neurologiques, Université Laval, Québec, Quebec, Canada.
Jerome
J
Paquet
Faculty of Medicine and Dentistry, Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
Richard
R
Fox
University of Toronto Spine Program, Toronto, Ontario, Canada.
Henry
H
Ahn
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Brian K
BK
Kwon
Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Daryl R
DR
Fourney
SCI center; acute SCI; geographic information science; trauma center; triage