The Effect of Hospital Transfer on Patient Outcomes After Rehabilitation for Spinal Injury

• Published in: World neurosurgery 2020-01, Vol.133, p.e76-e83
• Main Authors: Wilde, Herschel, Gamblin, Austin S., Reese, Jared, Garry, Jason G., Guan, Jian, Mortenson, Janel, Flis, Alexandra, Rosenbluth, Jeffrey P., Karsy, Michael, Bisson, Erica F., Dailey, Andrew T.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Aged; American Spinal Injury Association injury severity score; Continuity of Patient Care; Female; Functional independence measure; Hospital transfer; Hospitals, Community; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Outcomes; Patient Discharge; Patient Transfer; Recovery of Function; Rehabilitation; Spinal Cord Injuries - etiology; Spinal Cord Injuries - rehabilitation; Spinal Cord Injuries - surgery; Spinal cord injury; Spinal Injuries - complications; Spinal Injuries - rehabilitation; Spinal Injuries - surgery; Tertiary Care Centers; Trauma; Trauma Centers; Trauma Severity Indices; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.08.091

Spine fractures, including associated spinal cord injury, account for 3%–6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011–2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer.