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The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review

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Abstract

Objective

Current recommendations for traumatic spinal cord injury treatment recommend immediate transfer to a spinal injury unit (SIU) where available following patient stabilisation. Although transfer is dependent on a variety of factors, the largest review was unable to justify implementation of such units on the basis of insufficient and lack of quality data in favour of care at the SIU as opposed to non-SIU centres. Our study sought to investigate: are subspecialty spinal injury units (SIUs) able to provide superior care compared with traditional trauma/rehab units? Is the standard of care of acute spinal cord injured patients to be managed in SIU’s?

Method

A literature search was conducted across five major databases using the key terms: “spinal cord injury” AND “Spinal Injury Unit” OR “spinal rehabilitation” OR “spinal injury centre” OR “specialist care” OR “care requirements.”

Results

After review of over 500 studies, only 9 met inclusion criteria, 3 of which were past reviews. There were no relevant RCT’s obtained. Standardised roles of global SIU units are needed to deliver equitable and high quality care as current evidence demonstrates variable standards of care and service (mean LOS range: 16–174 days). There is low quality evidence supporting earlier admission into SIU units being associated with improved neurological outcome, complication rates and reduced LOS, despite variations in the definition of “early admission” across studies.

Conclusions

Our review demonstrates a lack of standardisation within SIU on a global scale, with significantly different outcomes reported across published studies. New and higher quality evidence directly comparing SIU to non-SIU based care is required. Earlier transfer (<24 h) to SIU following initial injury and stabilisation is advised.

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Abbreviations

SIU:

Spinal injury unit

TSCI:

Traumatic spinal cord injury

LOS:

Length of stay

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Authors and Affiliations

  1. Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia

    Monish M. Maharaj, Jarred A. Hogan, Kevin Phan & Ralph J. Mobbs

  2. NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Randwick, NSW, 2031, Australia

    Monish M. Maharaj, Jarred A. Hogan, Kevin Phan & Ralph J. Mobbs

  3. NeuroSpine Surgery Research Group (NSURG), Sydney, NSW, Australia

    Monish M. Maharaj, Jarred A. Hogan, Kevin Phan & Ralph J. Mobbs

Authors
  1. Monish M. Maharaj
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  2. Jarred A. Hogan
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  3. Kevin Phan
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  4. Ralph J. Mobbs
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Correspondence to Monish M. Maharaj.

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This project received no funding and all authors have no relevant conflicts of interest to disclose.

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Maharaj, M.M., Hogan, J.A., Phan, K. et al. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review. Eur Spine J 25, 1813–1820 (2016). https://doi.org/10.1007/s00586-016-4545-x

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  • DOI: https://doi.org/10.1007/s00586-016-4545-x

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