Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis

Abstract

Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than White patients. This study aims to investigate potential racial disparities in time to surgical decompression in patients with CCS. The National Trauma Data Bank was queried from 2017 to 2019 for patients who underwent surgery for CCS. The primary outcome was time from hospital admission to surgery. Student's t-test and Pearson's chi-squared test were used to evaluate differences in categorical and continuous variables, respectively. An uncensored Cox proportional hazards regression model was developed to assess the effect of race on surgical timing while adjusting for potential confounders. 1076 patients with CCS resulting in cervical spinal cord surgery were included in the analysis. Regression analysis results showed that Black patients (HR=0.85, p=0.03), female patients (HR=0.81, p<0.01), and patients treated at community hospitals (HR=0.82, p=0.01) were less likely to receive early surgery. Though the advantages of early surgical decompression in the setting of CCS have been detailed in medical literature, Black and female patients experience lower rates of prompt surgery following hospital admission and higher rates of adverse outcomes. This disproportionately increased time to intervention exemplifies demographic disparities in the timely provision of treatment to patients with spinal cord injuries.