Mapping the process of care in spinal cord injury: a substudy of the ICED trial
Traumatic spinal cord injury (SCI) has a devastating impact on individuals and their families, as many injuries result in severe paralysis and functional deficits. In the majority of cases the initial vertebral injury is compounded by secondary compression of the spinal cord.
Acute traumatic central cord syndrome (TCCS) is the most common type of incomplete cervical spinal cord injury. TCCS differs from the usual form of SCI as it generally results from a hyperextension injury in a patient with pre-existing narrowing of the spinal canal. TCCS can also result in paralysis and permanent functional deficits. Recent evidence suggests that the incidence of TCCS is increasing.
At present there is no standardized treatment for any of these spinal injuries, although early surgery to relieve spinal cord compression may improve neurological recovery. To minimize the time to early decompression, it is crucial to understand and determine the duration of each step in the process of care from accident scene through to surgery. This allows substantial delays to be identified and focused solutions can then be
developed to reduce these delays. The aim of this project is to map the process of care of people with SCI and TCCS to determine the timing of spinal decompression surgery and factors that influence surgical decisions.
Recently, we have completed a retrospective analysis of cervical SCI patients in Australia and NZ (2010-2013). We demonstrate that the time to surgical decompression improved over this period (2010: 31 hr vs. 2013: 18hr). The main factors contributing to delayed surgery were admission to a pre-surgical hospital, and time taken to access the operating theatre at a surgical centre. Strategies likely to further reduce the time to decompression are direct admission to a spinal surgical hospital and rapid access to the operating theatre.
We are currently mapping the process of care within Victoria for two further populations, thoracolumbar SCI and TCCS patients. This project is part of the Immediate Cooling and Emergency Decompression (ICED) trial.
- Dr. Peter Batchelor, Senior Lecturer
- Dr. Camila Battistuzzo, Post-Doctoral Research Fellow
- Peta Skeers, Research Assistant
- Austin Health
- Alfred Health
- Melbourne Health (Royal Melbourne Hospital)
- Royal Adelaide Hospital
- Royal Perth Hospital
- Princess Alexandra Hospital
- Middlemore Hospital
- Christchurch Hospital
- Immediate Cooling and Emergency Decompression (ICED) for the treatment of spinal cord injury: pilot, safety and feasibility studies (Neurotrauma-Funding Provider Project) awarded by Institute for Safety, Compensation and Recovery Research (ISCRR)
- Immediate Cooling and Emergency Decompression (ICED) for the treatment of spinal cord injury: pilot, safety and feasibility studies (Project Grant) awarded by NHMRC
This research project is available to PhD students to join as part of their thesis.
Please contact the Research Group Leader to discuss your options.
- Battistuzzo CR, Armstrong A,'''', and Batchelor PE. Early decompression following cervical spinal cord injury: Examining the process of care from accident scene to surgery. Journal of Neurotrauma (2015) (online ahead of print, March 2016).