{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:42:53Z","timestamp":1777927373222,"version":"3.51.4"},"reference-count":23,"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>\n                    Data supporting the benefits of early surgical intervention in acute spinal cord injury (SCI) is growing. For early surgery to be accomplished, understanding the causes of variabilities that effect the timing of surgery is needed to achieve this goal. The purpose of this analysis is to determine factors that affect the timing of surgery for acute cervical SCI within the North American Clinical Trials Network (NACTN) for SCI registry. Patients in the NACTN SCI registry from 2005 to 2019 with a cervical SCI, excluding acute traumatic central cord syndrome, were analyzed for time elapsed from injury to arrival to the hospital, and time to surgery. Two categories were defined: 1) Early Arrival with Early Surgery (EAES) commenced within 24\u2009h of injury, and 2) Early Arrival but Delayed Surgery (EADS), with surgery occurring between 24 to 72\u2009h post-injury. Patients' demographic features, initial clinical evaluation, medical comorbidities, neurological status, surgical intervention, complications, and outcome data were correlated with respect to the two arrival groups. Of the 222 acute cervical SCI patients undergoing surgery, 163 (73.4%) were EAES, and 59 (26.6%) were EADS. There was no statistical difference in arrival time between the EAES and EADS groups. There was a statistical difference in the median arrival time to surgery between the EAES group (9\u2009h) compared with the EADS group (31\u2009h;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). There was no statistical difference in race, sex, age, mechanism of injury, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores, or medical comorbidities between the two groups, but the EAES group did present with a significantly lower systolic blood pressure (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). EADS patients were more likely to present as an American Spinal Injury Association Impairment Scale (AIS) D than EAES (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Early surgery was statistically more likely to occur if the injury occurred over the weekend (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). There were variations in the rates of early surgery between the eight NACTN sites within the study, ranging from 57 to 100%. Of the 114 patients with 6-month outcome data, there was no significant change between the two groups regarding AIS grade change and motor\/pin prick\/light touch score recovery. A trend towards improved motor scores with early surgery was not statistically significant (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.21). Although there is data that surgery within 24\u2009h of injury improves outcomes and can be performed safely, there remain variations in care outside of clinical trials. In the present study of cervical SCI, NACTN achieved its goal of early surgery in 73.4% of patients from 2005-2019 who arrived within 24\u2009h of their injury. Variability in achieving this goal was related to severity of neurological injury, the day of the week, and the treating NACTN center. Evaluating variations within our network improves understanding of potential systemic limitations and our decision-making process to accomplish the goal of early surgery.\n                  <\/jats:p>","DOI":"10.1089\/neu.2022.0507","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T03:45:14Z","timestamp":1682480714000},"page":"1907-1917","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Variability in Early Surgery for Acute Cervical Spinal Cord Injury Patients: An Opportunity for Enhanced Care Delivery"],"prefix":"10.1177","volume":"40","author":[{"given":"Chris J.","family":"Neal","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, 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, Texas, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Abd-El-Barr","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina, 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":"Neuroscience Institute. 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":"Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, 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":"Robert G.","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA."}],"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"}]}],"member":"179","published-online":{"date-parts":[[2023,8,23]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032037"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-019-04031-y"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.3171\/spi.1999.91.1.0012"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5132"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/foc.1999.6.1.4"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2016.177"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217706367"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.6156"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(20)30406-3"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2014.3767"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6606"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2012.2539"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000000883"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2016.1165448"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.2969"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.5.Aospine1289"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.4.Aospine1294"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.4.Aospine1259"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318276f64b"},{"key":"e_1_3_5_21_2","unstructured":"Fehlings 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AO Spine-Praxis Guidelines for the Timing of Surgical Management in Patients with Traumatic Spinal Cord Injury. 2022."},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000003165"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.4258"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-021-06982-2"}],"container-title":["Journal of Neurotrauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/neu.2022.0507","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2022.0507","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/neu.2022.0507","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:42:19Z","timestamp":1777675339000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/neu.2022.0507"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,23]]},"references-count":23,"journal-issue":{"issue":"17-18","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1089\/neu.2022.0507"],"URL":"https:\/\/doi.org\/10.1089\/neu.2022.0507","relation":{},"ISSN":["0897-7151","1557-9042"],"issn-type":[{"value":"0897-7151","type":"print"},{"value":"1557-9042","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,23]]}}}