{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:40:56Z","timestamp":1777927256385,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"21","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>Substantial clinical data support an association between superior neurological outcomes and early (within 24\u2009h) surgical decompression for those with traumatic cervical spinal cord injury (SCI). Despite this, much discussion persists around feasibility and safety of this time threshold, particularly for those with a complete cervical SCI. This study aims to assess clinical practices and the safety profile of early surgery across a large sample of North American trauma centers. Data were derived from the Trauma Quality Improvement Program database from 2010\u20132016. Adult patients with a complete cervical SCI (American Spinal Injury Association [ASIA] A) who underwent surgery were included. Patients were stratified into those receiving surgery at or before 24\u2009h and those receiving delayed intervention. Risk-adjusted variability in surgical timing across trauma centers was investigated using mixed-effects regression. In-hospital adverse events including death, major complications, and immobility-related complications were compared between groups after propensity score matching. There were 2862 patients from 353 North American trauma centers included; 1760 (61.5%) underwent surgery within 24\u2009h. Case-mix and hospital-level characteristics explained only 6% of the variability in surgical timing both between centers and within centers. No significant differences in adverse events were identified between groups. These findings suggest a relatively large proportion of patients are not receiving surgery within the recommended time frame, despite apparent safety. Moreover, patient and hospital-level characteristics explain little of the variability in time-to-surgery. Further knowledge translation is needed to increase the proportion of patients in whom surgery is performed before the 24-h threshold so patients might reach their greatest potential for neurological recovery.<\/jats:p>","DOI":"10.1089\/neu.2021.0177","type":"journal-article","created":{"date-parts":[[2021,8,12]],"date-time":"2021-08-12T05:29:46Z","timestamp":1628746186000},"page":"3011-3019","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Reality of Accomplishing Surgery within 24 Hours for Complete Cervical Spinal Cord Injury: Clinical Practices and Safety"],"prefix":"10.1177","volume":"38","author":[{"given":"Michael","family":"Balas","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Pr\u00f6mmel","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."},{"name":"Department of Neurosurgery, Cantonal Hospital, St. Gallen, Switzerland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Nguyen","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Ottawa, Ottawa, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S.","family":"Jack","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Lebovic","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jetan H.","family":"Badhiwala","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leodante","family":"da Costa","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."},{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avery B.","family":"Nathens","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada."},{"name":"Division of General Surgery, Department of Surgery, and University of Toronto, Toronto, Ontario, Canada."},{"name":"MediTrauma Quality Improvement Program, American College of Surgeons, Chicago, Illinois, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."},{"name":"Spine Program, Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jefferson R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."},{"name":"Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher D.","family":"Witiw","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada."},{"name":"Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000287"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30406-3"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032037"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568219877860"},{"key":"e_1_3_6_6_2","doi-asserted-by":"crossref","unstructured":"Fehlings M.G. 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