929 Outcomes in Pediatric Spinal Cord Injuries Based on Time to Surgery

Abstract

INTRODUCTION: Early surgery in individuals with traumatic spinal cord injury (SCI) has been associated with improved neurological recovery, lower risk of complications, and reduced resource utilization. Patient and healthcare-related factors may contribute to delay in surgery. This study aimed to determine factors contributing to longer time-to-surgery in pediatric patients with complete and incomplete SCI. METHODS: Patients with SCI were identified in the National Trauma Data Bank based on AIS codes. Patients who died in the ED or were transferred to another hospital were excluded. Procedure codes were used to identify patients who underwent spinal surgery. Patients were grouped by time to surgery less than or greater than 12 hours. RESULTS: 549 patients were identified with 235 incomplete and 314 complete SCI. 399 patients underwent surgery (177 incomplete; 222 complete). Of patients who underwent surgery, 55% of incomplete and 52% of complete SCI went to surgery after 12 hours. SCI patients with greater than 12-hour time-to-surgery had worse injury severity scores (32 vs 28, p < 0.05). Additionally, ICU LOS, total ventilation days, and total LOS were longer. Time-to-surgery greater than 12 hours was statistically associated with unplanned ICU stay (incomplete), unplanned OR (complete), ventilator associated pneumonia (complete), and delirium (incomplete). Time-to-surgery was not significantly associated with race, gender, or mechanism of injury. pneumonia (complete), and delirium (incomplete). Time-to-surgery was not significantly associated with race, gender, or mechanism of injury. CONCLUSIONS: Greater time-to-surgery is associated with higher risk of complications and longer hospital stays in patients with complete and incomplete SCI in the pediatric population. This data raises the question as to whether earlier surgery could reduce complications.