Association Between Trauma Center Designation and Spinal Cord Injury Admission in the USA

Abstract

Background: After spinal cord injury (SCI), patients are seen in either trauma center emergency departments (EDs) or non-trauma center EDs, and then selectively admitted for hospitalization. The association between SCI and admission to designated trauma centers is currently unknown. In this study, we assess the trends in admission between designated trauma centers after SCI from a large multi-center nationwide registry. Methods: In this retrospective analysis of the Nationwide Emergency Department Sample (NEDS), we identified visits with SCI from 2006 to 2014. Z-test analyses were used to compare patients diagnosed with SCI at EDs with an associated trauma center designated hospital (TC-visits) against patients diagnosed with SCI at EDs without an associated trauma center designated hospital (NTC-visits). Results: A total of 516,716 reported visits were identified with SCI. The annual total ED visits with admission to the same hospital for patients diagnosed with SCI increased significantly from 39,129 to 50,127 from 2006 to 2014 (P < 0.001). From 2006 to 2014, the annual ED visits and admissions from TC-visits increased significantly from 27,781 to 43,926 and 23,445 to 35,635, respectively (P < 0.0001, P < 0.0001). However, the annual ED visits and admissions from NTC-visits did not change significantly from 23,938 to 22,107 and 15,683 to 14,493, respectively (P = 0.09 and P = 0.1). Throughout the entire study period, the annual total ED visits with admissions to the same hospital was significantly higher for TC-visits than NTC-visits diagnosed with SCI (P < 0.0001). The mean length of stay (14.1 days vs. 8.1 days), annual total in-hospital mortality (6.8% vs. 6.0%), and annual total discharges to another institution (53.8% vs. 46.8%) were significantly higher in TC-visits throughout the study period (P < 0.001). However, the annual total routine discharges (27.2% vs. 26.4%), annual total discharges to short-term hospital (12.4% vs. 7.2%), and annual total discharges to home health care (7.7% vs. 4.4%) were significantly higher in NTC-visits throughout the study period (P < 0.001). Conclusions: Of the population of patients with SCI who visit EDs, those seen at trauma centers have a significant parallel association with incidence and patient outcome compared against those seen at non-trauma centers. Prospective research is warranted to make recommendations for required healthcare infrastructures based on an institution’s trauma center designation. J Neurol Res. 2020;10(5):193-198 doi: https://doi.org/10.14740/jnr609