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Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24\u2009h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged \u226516\u2009years with incident TSCI in NSW (2013\u20132016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Inclusion criteria identified 316 patients, geospatial analysis showed that over half (53%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009168) of all patients were injured within 60\u2009min road travel of a SCIU, yet only 28.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200948) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) but higher ICISS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), cervical injury (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), and transferred by air-ambulance (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) or incomplete injury (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Patients not admitted to SCIU at all were older (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05) with lower levels of injury (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Complications included pressure injury, deep vein thrombosis, urinary infection, among others.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Getting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. The higher rates of complication following delayed transfer to a SCIU should motivate health service policy makers to investigate reasons for this practice and consent to improvement strategies. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60\u2009min radius, enabling the benefits of specialised care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-021-06235-4","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T03:29:49Z","timestamp":1617247789000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8977-6144","authenticated-orcid":false,"given":"Lisa N.","family":"Sharwood","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Whyatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharat P.","family":"Vaikuntam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiana L.","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa K.","family":"Noonan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony P.","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathon","family":"Ball","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph E.","family":"Stanford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei-Ruu","family":"Kok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel R.","family":"Withers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W.","family":"Middleton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"issue":"1","key":"6235_CR1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1310\/sci1801-57","volume":"18","author":"D Atkins","year":"2012","unstructured":"Atkins D, Noonan V, Santos A, Lewis R, Fehlings M, Burns A, et al. 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Data custodian approvals were provided by Dr. Lee Taylor for the APDC, Dr. Rosemary Carney for the NSW Ambulance dataset, Ms. Amanda Ianna for the RBDM dataset and Mr. Alfa D\u2019Amato for the NSW-DNR dataset.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable as this project used de-identified administrative data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Lisa N. Sharwood is an Editorial Board Member of the BMC Health Services Research journal. The conducted work or its submission was not influenced by this role. No other authors declare any competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"292"}}