Faculty Bibliography

BACKGROUND:To evaluate the effect of operative timing on functional outcome in patients suffering spinal trauma, we conducted a retrospective analysis of the National Trauma Data Bank. By treating time to operation as a categorical variable and limiting our analysis to isolated spinal trauma, we hypothesized that time to operation would not be a predictor of functional outcome. METHODS:The National Trauma Data Bank was queried for all patients with isolated spinal trauma who underwent spinal fixation or decompression. Functional outcomes at the time of hospital discharge were measured using Functional Independent Motor Locomotion Score. Generalized ordered logistic model was used to determine the effect of time until operation on functional outcomes. Gender, age, injury severity, the level of trauma center, and the presence of spinal cord injury were included as covariates. RESULTS:Of the final sample of 1,848 patients (mean age 44.3 years), 78% were White and 71% male. Fifty-seven percent of patients had Injury Severity Score between 8 and 15, with the remainder having Injury Severity Score ≤8. Forty-five percent were treated at a Level I trauma center. Using generalized ordered logistic regression, time to operation was not a significant predictor of functional outcomes, whereas treatment at Level I trauma centers seemed to confer marginally better outcomes. CONCLUSIONS:In patients with isolated spinal trauma, time until spinal operation does not seem to be an important predictor of functional outcome at the time of hospital discharge. Operative timing, at the discretion of the surgeon, needs to consider the risks and benefits associated with delayed versus emergent operation.

BACKGROUND:Postacute care is an essential component of medical care aimed at returning trauma patients to their preinjury functional status. Rehabilitation services, skilled nursing facilities, and home care all play a role in facilitating the healing process. Access to such care may be limited based on insurance status, leaving the uninsured with limited resources to reach full recovery. We hypothesized that access to specialized postacute care is less available to patients who lack health insurance. METHODS:A retrospective cohort of trauma patients in the National Trauma Databank from 2002 to 2006 was assessed to determine whether insurance status was a predictor of discharge to a specialized postacute care facility (rehabilitation, skilled nursing facilities, and home health). Using multivariate logistic regression, we assessed the likelihood of discharge to such facilities on the basis of insurance status, controlling for patient demographics and injury severity. RESULTS:Adjusting for variation in age, race/ethicity, gender, and injury type and severity, uninsured patients had the lowest odds of being discharged to a skilled nursing facility (odds ratio [OR], 0.76; 95% confidence interval [CI] 0.73-0.80; p<0.001), home health (OR, 0.51; 95% CI 0.49-0.53; p<0.001), and rehabilitation (OR, 0.45; 95% CI 0.44-0.46; p<0.001). Uninsured patients had the highest odds, however, of being discharged directly home (OR, 1.32; 95% CI 1.30-1.34; p<0.001). CONCLUSION/CONCLUSIONS:Insurance status is an important predictor of hospital disposition and access to specialized posthospital care. Uninsured patients are less likely to have access to the full range of medical care available to ensure complete recovery from traumatic injuries.