Timing of surgery for children and adolescents sustaining complete traumatic spinal cord injury.

Objective: Spinal cord injury (SCI) trials have historically underrepresented pediatric patients. There are limited pediatric data examining the influence of surgical timing on complications and mortality for children and adolescents who have sustained complete traumatic SCI.

Methods: The following multicenter cohort study used Trauma Quality Improvement Program data from 2010 to 2020. The authors identified pediatric patients (aged < 18 years) who sustained complete traumatic SCI and underwent surgical intervention within 7 days of admission. Propensity score matching was performed between patients who underwent surgery within 24 hours versus ≥ 24 hours. The authors then assessed differences for the following outcomes: major in-hospital complications, immobility-related complications, length of stay (LOS), and mortality.

Results: There were 837 patients with complete traumatic SCI managed across 297 trauma centers identified for study inclusion (70% underwent early surgery). After matching, 494 patients were available for analysis. Patients undergoing delayed surgery experienced longer ICU LOS (mean difference 3.74 days, 95% CI 0.91-6.57 days) and more major in-hospital complications (OR 1.77, 95% CI 1.16-2.73) and immobility-related complications (OR 2.09, 95% CI 1.25-3.56). There were no differences in mortality between groups. Younger age, non-White race, penetrating injuries, lower Glasgow Coma Scale score at admission, severe concomitant abdominal injuries, and motor vehicle collision injury mechanisms were associated with increased time to surgery.

Conclusions: The authors demonstrated an association between early surgery and shorter ICU LOS and reduced in-hospital complications. Future work is needed to quantify the impact of surgical timing on functional neurological outcomes and to explore upstream social determinants of health influencing timing of surgery.