{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:42:37Z","timestamp":1777927357506,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"17-18","license":[{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"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":[[2023,9]]},"abstract":"<jats:p>The North America Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that has maintained a prospective SCI registry since 2004, and it has espoused that early surgical intervention is associated with improved outcome. It has previously been shown that initial presentation to a lower acuity center and necessity of transfer to a higher acuity center reduce rates of early surgery. The NACTN database was evaluated to examine the association between interhospital transfer (IHT), early surgery, and outcome, taking into account distance traveled and site of origin for the patient.<\/jats:p>\n                  <jats:p>\n                    Data from a 15-year period of the NACTN SCI Registry were analyzed (years 2005\u20132019). Patients were stratified into transfers directly from the scene to a Level 1 trauma center (NACTN site) versus IHT from a Level 2 or 3 trauma facility. The main outcome was surgery within 24\u2009hours of injury (yes\/no), whereas secondary outcomes were length of stay, death, discharge disposition, and 6-month American Spinal Injury Association Impairment Scale (AIS) grade conversion. For the IHT patients, distance traveled for transfer was calculated by measuring the shortest distance between origin and NACTN hospital. Analysis was performed with Brown-Mood test and chi-square tests. Of 724 patients with transfer data, 295 (40%) underwent IHT and 429 (60%) were admitted directly from the scene of injury. Patients who underwent IHT were more likely to have a less severe SCI (AIS D;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.002), have a central cord injury (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.004), and have a fall as their mechanism of injury (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001) than those directly admitted to an NACTN center. Of the 634 patients who had surgery, direct admission to an NACTN site was more likely to result in surgery within 24\u2009hours compared with IHT patients (52% vs. 38%) (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0003). Median IHT distance was 28 miles (interquartile range [IQR]\u2009=\u200913\u201362 miles). There was no significant difference in death, length of stay, discharge to a rehab facility versus home, or 6-month AIS grade conversion rates between the two groups. Patients who underwent IHT to an NACTN site were less likely to have surgery within 24\u2009hours of injury, compared with those directly admitted to the Level 1 trauma facility. Although there was no difference in mortality rates, length of stay, or 6-month AIS conversion between groups, patients with IHT were more likely be older with a less severe level of injury (AIS D). This study suggests there are barriers to timely recognition of SCI in the field, appropriate admission to a higher level of care after recognition, and challenges related to the management of individuals with less severe SCI.\n                  <\/jats:p>","DOI":"10.1089\/neu.2022.0408","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T08:09:06Z","timestamp":1680595746000},"page":"1928-1937","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Interhospital Transfer Delays Care for Spinal Cord Injury Patients: A Report from the North American Clinical Trials Network for Spinal Cord Injury"],"prefix":"10.1177","volume":"40","author":[{"given":"Margot","family":"Kelly-Hedrick","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Ugiliweneza","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Louisville, Kentucky, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth G.","family":"Toups","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston TX, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Jimsheleishvili","sequence":"additional","affiliation":[{"name":"The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shekar N.","family":"Kurpad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bizhan","family":"Aarabi","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norah","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Miami Valley Hospital, Centerville, Ohio, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory C.","family":"Goodwin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles H.","family":"Tator","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Guest","sequence":"additional","affiliation":[{"name":"The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris 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