Epidemiology characteristics of acute traumatic spinal cord injury in primary hospitals and the impact of "group-based" intensive assistance on their diagnosis and treatment capacities

English Keywords:Traumatic spinal cord injury  Epidemiology  Primary hospital  "Group-based" assistance  Diagnosis and treatment capacity

English Abstract:

  【Abstract】 Objectives: To clarify the epidemiological characteristics of patients with acute traumatic spinal cord injury(TSCI) who were first diagnosed in primary hospitals, and to investigate the effect of "group-based" intensive assistance provided by high-level grade A tertiary public hospitals on improving the diagnosis and treatment capacity of primary hospitals for TSCI. Methods: A retrospective analysis was conducted on 252 TSCI patients who were first admitted to Huazhou People′s Hospital from January 2016 to December 2022. Taking the launch of "group-based" intensive assistance by Nanfang Hospital of Southern Medical University in 2019 as the time node, the patients were divided into two groups: pre-assistance group(2016-2018, n=91) and post-assistance group(2019-2022, n=161). The epidemiological characteristics of patients(including gender, age, causes of injury, injury sites, and presence of other concurrent traumatic injuries) as well as changes in diagnosis and treatment-related indicators(including surgical rate, functional improvement rate, ICU admission status, and rescue interventions) were compared between the two groups. Results: Among the 252 patients, 192 were male(76.19%) and 60 were female(23.81%), with a median age of 55.50(43.25, 64.00) years. The main causes of injury were falling from height(81 cases, 32.14%), traffic accidents(75 cases, 29.76%), and falling from low altitude(<2m, 73 cases, 28.97%). The most common injury site was cervical spine(204 cases, 80.95%). A total of 75.00%(189/252) of the patients were complicated with injuries in other parts, among which 32.93%(83/252) had multiple injuries. The median time from trauma to hospital admission was 3.00(2.00, 5.00)h. In terms of ASIA impairment scale, grade D accounted for the highest proportion(58.73%, 148/252). After the assistance, the proportion of patients with grade A and B increased from 7.69%(7/91) to 25.47%(41/161)(P<0.001). The surgical treatment rate increased from 6.59%(6/91) before assistance to 40.37%(65/161) after assistance(P<0.001); The neurological function improvement rate at discharge increased from 34.07%(31/91) to 54.66%(88/161)(P<0.001). Conclusions: TSCI patients in primary hospitals are predominantly male and tend to be middle aged or elderly, with cervical injuries and multiple trauma being common, mainly caused by falls and traffic accidents. The "group-based" intensive support from high level tertiary hospitals can significantly improve the comprehensive treatment capacity for TSCI in primary hospitals.