alexa Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord Injury
ISSN: 2165-7548

Emergency Medicine: Open Access
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Research Article

Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord Injury

Sharwood LN1,2,3*, Boufous S4, Muecke S5 and Middleton JW1,2,6

1John Walsh Centre for Rehabilitation Research, Kolling Institute, Australia

2Sydney Medical School Northern, University of Sydney, Australia

3Department of Preventive Medicine, Monash University, Australia

4University of New South Wales, Australia

5NSW Ambulance, Australia

6State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, Australia

*Corresponding Author:
Sharwood LN
John Walsh Centre for Rehabilitation Research
Kolling Institute, Northern Clinical School
University of Sydney, Reserve Road
St Leonards, NSW 2065, Australia
Tel: +61 409838096
E-mail: [email protected]

Received Date: May 19, 2017; Accepted Date: May 31, 2017; Published Date: June 06, 2017

Citation: Sharwood LN, Boufous S, Muecke S, Middleton JW (2017) Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord Injury. Emerg Med (Los Angel) 7: 353. doi: 10.4172/2165-7548.1000353

Copyright: © 2017 Sharwood LN, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License; which permits unrestricted use; distribution; and reproduction in any medium; provided the original author and source are credited.

 

Abstract

Background: Addressing policy change in traumatic injury care demands a strong evidence base from which to inform necessary amendments, and measure the impact of any change. Current recommendations for acute traumatic spinal cord injury include admission to a specialist Spinal Cord Injury Unit within 24 hours from injury. This study aimed to document pathways for patients with traumatic spinal cord injury across a state-wide Health Service in a historical cohort, prior to and in order to inform trauma policy changes. Methods: Retrospective analysis of a large Ambulance service record-linked dataset, containing 2.04 million Ambulance records linked with hospital and death records (2006-09). Incident cases of traumatic spinal cord injury were identified using ICD-10-AM codes. Multivariate analysis aimed to identify factors associated with admission to specialist units within 24 hours. Results: Of 311 patients with confirmed traumatic spinal cord injury, 177 (56.9%) were admitted to a specialist Spinal Cord Injury Unit, with 130 of these (73.4%) being within 24 hours post injury. The remaining 47 (26.6%) had up to several months delayed transfer to SCIU. Patients were significantly more likely to have timely admission to SCIU with a cervical level cord injury (OR 2.05), aeromedical transfer to a specialist unit (OR 2.5), outer regional geographic location of injury (OR 2.05), or a surgical spinal procedure within 24 hours (OR 3.1). Patients were significantly less likely to be admitted to a specialist unit within 24 hours were those who experienced more than one hospital transfer (OR 0.28), and patients >75 years (OR 0.35). Conclusion: Historically across this state-wide Health Service, patients with traumatic spinal cord injury did not experience consistent treatment pathways. Publication of this study importantly provides a baseline from which changes to clinical policies that have occurred since 2009 can be evaluated.

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