Health Service Pathways Analysis as Evidence Base for Trauma Policy Change: A Retrospective Study of Patients with Traumatic Spinal Cord InjurySharwood LN1,2,3*, Boufous S4, Muecke S5 and Middleton JW1,2,6
- *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.
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.