Trends in Demographics and Markers of Injury Severity in Traumatic Cervical Spinal Cord Injury.

Over the past four decades, there have been progressive changes in the epidemiology of traumatic spinal cord injury (tSCI). We assessed trends in demographic and injury-related variables in traumatic cervical spinal cord injury (tCSCI) patients over an 18-year period at a single Level I trauma center. We included all magnetic resonance imaging-confirmed tCSCI patients ≥15 years of age for years 2001-2018. Among 1420 patients, 78.3% were male with a mean age 51.5 years. Etiology included falls (46.9%), motor vehicle collisions (MVCs; 34.2%), and sports injuries (10.9%). Median American Spinal Injury Association (ASIA) Motor Score (AMS) was 44, complete tCSCI was noted in 29.6% of patients, fracture dislocations were noted in 44.7%, and median intramedullary lesion length (IMLL) was 30.8 mm (complete injuries 56.3 mm and incomplete injuries 27.4 mm). Over the study period, mean age and proportion of falls increased (p < 0.001) whereas proportion attributable to MVCs and sports injuries decreased (p < 0.001). Incomplete injuries, AMS, and the proportion of patients with no fracture dislocations increased whereas complete injuries decreased significantly. IMLL declined (p = 0.17) and proportion with hematomyelia did not change significantly. In adjusted regression models, increase in age and decreases in prevalence of MVC mechanism and complete injuries over time remained statistically significant. Changes in demographic and injury-related characteristics of tCSCI patients over time may help explain the observed improvement in outcomes. Further, improved clinical outcomes and drop in IMLL may reflect improvements in initial risk assessment and pre-hospital management, advances in healthcare delivery, and preventive measures including public education.

Comparison of Maryland hospital discharge and trauma registry data.

BACKGROUND: This study aimed to examine the validity of using Maryland hospital discharge data to characterize injuries sustained by trauma patients. METHODS: Maryland hospital discharge and Maryland trauma registry data for 1999 were merged, and the extent of agreement regarding the presence and severity of injuries sustained was evaluated. RESULTS: The mean Injury Severity Score was 8.4 according to the Maryland hospital discharge data and 10 according to the Maryland trauma registry data (p < 0.0001). The Maryland hospital discharge data identified 95% or more of all moderate to severe injuries (Abbreviated Injury Score, > or =2) for all body regions except the head. There was substantial agreement between the two data sets for mechanism of injury (weighted kappa, 0.62), the number of preexisting conditions present (weighted kappa, 0.45) and final disposition (weighted kappa, 0.78). CONCLUSIONS: The Maryland hospital discharge data are a valid source for documenting the nature and severity of injuries sustained by trauma patients, except for those with a relatively minor head injury.

Validity of administrative data for characterizing traumatic brain injury-related hospitalizations.

PRIMARY OBJECTIVE: To examine the validity of Maryland Hospital Discharge (MHD) data for identifying and characterizing traumatic brain injury (TBI)-related hospitalizations. METHODS: All TBI-related hospitalizations in 1999 were identified using MHD and Maryland Trauma Registry (MTR) data. In addition, a sample of records were abstracted to compare agreement between MHD and chart data. RESULTS: The MHD file identified fewer TBI cases (61%) compared to the MTR (95%). Overall, TBI-related hospitalization rates based on MHD were significantly fewer (95; 95% CI 92, 98) vs MHD and MTR (144; 95% CI 140, 147). There was good agreement between the MHD and chart data regarding skull fractures or intracranial lesions (kappa = 0.73 and 0.83, respectively), but poor agreement for neurologic abnormalities or amnesia. The MHD significantly underestimated TBI severity. CONCLUSIONS: TBI cases, especially mild ones, were under-reported by MHD data. MHD data are better at detecting anatomic injuries compared to TBI symptoms and sequella.