Delays in Presentation After Traumatic Spinal Cord Injury-A Systematic Review

BOOTStrap-SCI: Beyond One option of treatment for spinal trauma and spinal cord injury: Consensus-based stratified protocols for pre-hospital care and emergency room (part I)

Introduction

Spinal trauma (STx), with or without spinal cord injury (SCI), represents a significant global health burden, particularly in low- and middle-income countries (LMICs). Existing guidelines often rely on tools and resources that are not always universally available, especially in less resourced settings, contributing to disparities in care and outcomes. A pragmatic, resource-adapted approach may help optimize management in these contexts.

Research question

This study aimed to develop resource-adapted protocols for pre-hospital and emergency room management of STx and SCI, addressing challenges specific to LMICs while supported by clinical evidence and expert based practices.

Material and methods

A multidisciplinary Delphi consensus combined international evidence-based guidelines with expert opinions. Iterative discussions and voting by healthcare providers from LMICs and high-income countries (HICs) ensured the development of context-sensitive protocols. These were tailored to varying levels of training, resource availability, and healthcare infrastructure.

Results

The resulting protocols address key areas of pre-hospital and emergency management, including initial resuscitation, immobilization, clinical interventions, and timely referral. These protocols emphasize adaptability, providing structured plus flexible guidance for optimizing care according to specific contexts from low to high resourced clinical settings.

Discussion and conclusion

The proposed protocols are not intended as gold-standard guidelines but as adaptable frameworks to guide management of STx/SCI in contexts with different availability of resources. By addressing disparities in resource availability and clinical competencies, they can serve as a foundation for local adaptations and improvements in care. Future research should evaluate their implementation and impact on outcomes.

Obstacles in "Time to Spine": Challenges for the Timely Delivery of Acute Surgical Care for Patients with Traumatic and Non-Traumatic Spinal Cord Injury

Over the past three decades, advancements in our understanding of the pathophysiology of spinal cord injury (SCI) have underscored the critical importance of early treatment for both traumatic and non-traumatic cases. Early surgical intervention significantly improves outcomes by limiting the extent of secondary damage. Despite numerous studies highlighting the superior outcomes associated with early decompression surgery for patients with SCIs, hospital reviews reveal that less than 60% of patients undergo surgical decompression within 24 h of injury. This occurs despite consensus among physicians regarding the benefits of early surgery. Therefore, it is important to highlight the multifactorial causes of this knowledge to action discordance. This review aims to elucidate the administrative, logistical, and technical challenges that hinder timely access to surgery for SCIs.

Composition of the editorial staff of major spinal journals based on geo-economic background: A survey analysis

Background

The widespread absence of papers originating in low and middle income economies (LAMIE) across various scholarly disciplines has been widely acknowledged. One potential reason for this could be editorial biases against submissions from LAMIE. Although this bias has been observed in different academic areas, its extent in spinal research remains largely uninvestigated. This research endeavored to investigate the composition of editorial staff members (ESM) within major spinal journals and scrutinize the degree of international diversity represented among the ESM.

Methods

We pinpointed ten major spinal journals by referencing their presence in the Journal Citation Reports of 2021. Countries of the ESM affiliated with these journals were categorized according to World Bank classifications. Following this, we conducted a thorough analysis of the ESM compositions.

Results

A total of 982 ESM from 50 countries were identified. The United States exhibited the highest representation among ESM (395, 40.22%), followed by South Korea (57, 5.80%), Switzerland (53, 5.40%). When segmented by geographical regions, North America emerged with the highest representation, constituting 43.38% of ESM at 426, trailed by Europe & Central Asia at 31.16% (306), East Asia & Pacific at 17.92% (175). The majority of ESM, amounting to 87.98%, hailed from high income economies (HIE). There was an absence of ESM representation of low income economies. The relationship regarding the quantity of ESM in each country and its population failed to demonstrate significance (p = 0.274, r = 0.281). However, a notable positive correlation emerged when exploring the connection between ESM numbers and gross domestic product (p = 0.033, r = 0.517).

Conclusions

Major spinal journals exhibit a notable absence of international representation within their editorial boards, predominantly comprising members from HIE. This underscores a substantial underrepresentation of ESM originating from LAMIE within the sphere of spinal investigation.

Concomitant Traumatic Brain Injury Delays Surgery in Patients With Traumatic Spinal Cord Injury

BACKGROUND AND OBJECTIVES

Growing evidence supports prompt surgical decompression for patients with traumatic spinal cord injury (tSCI). Rates of concomitant tSCI and traumatic brain injury (TBI) range from 10% to 30%. Concomitant TBI may delay tSCI diagnosis and surgical intervention. Little is known about real-world management of this common injury constellation that carries significant clinical consequences. This study aimed to quantify the impact of concomitant TBI on surgical timing in a national cohort of patients with tSCI.

METHODS

Patient data were obtained from the National Trauma Data Bank (2007-2016). Patients admitted for tSCI and who received surgical intervention were included. Delayed surgical intervention was defined as surgery after 24 hours of admission. Multivariable hierarchical regression models were constructed to measure the risk-adjusted association between concomitant TBI and delayed surgical intervention. Secondary outcome included favorable discharge status.

RESULTS

We identified 14 964 patients with surgically managed tSCI across 377 North American trauma centers, of whom 2444 (16.3%) had concomitant TBI and 4610 (30.8%) had central cord syndrome (CCS). The median time to surgery was 20.0 hours for patients without concomitant TBI and 24.8 hours for patients with concomitant TBI. Hierarchical regression modeling revealed that concomitant TBI was independently associated with delayed surgery in patients with tSCI (odds ratio [OR], 1.3; 95% CI, 1.1-1.6). Although CCS was associated with delayed surgery (OR, 1.5; 95% CI, 1.4-1.7), we did not observe a significant interaction between concomitant TBI and CCS. In the subset of patients with concomitant tSCI and TBI, patients with severe TBI were significantly more likely to experience a surgical delay than patients with mild TBI (OR, 1.4; 95% CI, 1.0-1.9).

CONCLUSION

Concomitant TBI delays surgical management for patients with tSCI. This effect is largest for patients with tSCI with severe TBI. These findings should serve to increase awareness of concomitant TBI and tSCI and the likelihood that this may delay time-sensitive surgery.

Burden of Traumatic Spinal Cord Injury in Sub-Saharan Africa: A Scoping Review

INTRODUCTION

With a varying annual incidence across populations, traumatic spinal cord injury (TSCI) remains a public health concern of utmost importance, especially in developing countries with an incidence rate ranging from 12.7 to 29.7 per million people and a postulated increase in the number of patients living with undesirable complications of this condition. It is against this background that we reviewed the literature to bring to light the epidemiology, burden, management, and outcomes of TSCIs across Africa.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in this study. We included descriptive studies with data on the incidence, presentation, management, and outcomes of TSCIs in African surgical centers. We conducted our search on PubMed and OVID Embase and supplemented it with an extensive review of African Journal Online and Google Scholar.

RESULTS

Thirteen papers were identified from our search. Most papers were from Nigeria (n = 4) and Tanzania (n = 3). In total, our review included 1332 persons across the different centers. There were more males than females (n = 1029/1332, 72%). The most common etiology was road traffic accidents, constituting 44%, while falls and other mechanisms like assault and sports injuries had 28% each. The incidence of TSCI varied from 13 per million population per year in Botswana to 75.6 per million population per year in South Africa.

CONCLUSIONS

The incidence of the traumatic condition in certain parts of Africa is significantly higher than in other parts of the world, suggesting the need for an urgent call to action regarding addressing its key drivers.