Concomitant Traumatic Brain Injury Delays Surgery in Patients with Traumatic Spinal Cord Injury

Wednesday, February 21, 2024

Presenting Author(s)

Tej D. Azad, MD, MS

Resident
Department of Neurosurgery, The Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

AB

Ali Bydon, MD

Professor
Johns Hopkins University
Baltimore, Maryland, United States
JB

James Byrne, MD PhD

Professor of Surgery
Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine
Baltimore, United States
Daniel Lubelski, MD

Assistant Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
DR

Divyaansh Raj, BA (he/him/his)

Medical Student
Johns Hopkins School of Medicine
Livingston, New Jersey, United States
KR

Kathleen R. Ran, AB (she/her/hers)

Medical Student
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
VV

Vikas Vattipally, BA

Medical Student
Department of Neurosurgery, The Johns Hopkins University School of Medicine, United States
AW

Anmol Warman, BS

Medical student
Johns Hopkins School of Medicine, United States
JW

John Williams, MD

Assistant Professor
UT Houston
Seattle, Washington, United States
TW

Timothy Witham, MD

Professor
Johns Hopkins University
Towson, Maryland, United States
CW

Christopher Witiw, MD, MS, FRCSC

Assistant Professor
University of Toronto
Chicago, Illinois, United States

Introduction: Growing evidence supports prompt intervention for patients with traumatic spinal cord injury (tSCI). Rates of concomitant tSCI and traumatic brain injury (TBI) range from 10-30%. Concomitant TBI may delay tSCI diagnosis and surgical intervention. Little is known about real-world management of this common injury constellation. This study aimed to quantify the impact of concomitant TBI on surgical timing in a national cohort of tSCI patients.

Methods: Patient data were obtained from the National Trauma Data Bank (2007-2016). Patients admitted for tSCI and who received surgical intervention were included. Delayed surgical intervention was defined as surgery after 24 hours of admission. Multivariable hierarchical regression models were constructed to measure the risk-adjusted association between concomitant TBI and delayed surgical intervention. Secondary outcome included favorable discharge status.

Results: We identified 14,964 patients with surgically managed tSCI across 377 North American trauma centers, of whom 2,444 (16.3%) had concomitant TBI and 4,610 (30.8%) had central cord syndrome (CCS). Median time to surgery was 20.0 hours for patients without concomitant TBI and 24.8 hours for patients with concomitant TBI. Hierarchical regression modeling revealed that concomitant TBI was independently associated with delayed surgery in patients with tSCI (OR, 1.3; 95% CI, 1.1-1.6). While CCS was associated with delayed surgery (OR, 1.5; 95% CI, 1.4-1.7), we did not observe a significant interaction between concomitant TBI and CCS. In the subset of patients with concomitant tSCI and TBI, patients with severe TBI were significantly more likely to experience a surgical delay than patients with mild TBI (OR, 1.4; 95% CI, 1.0-1.9).

Conclusion : Concomitant TBI delays surgical management for patients with tSCI. This effect is largest for tSCI patients with severe TBI. These findings should serve to increase awareness of concomitant TBI and tSCI and the likelihood that this may delay time-sensitive surgery.