{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:16:59Z","timestamp":1788308219493,"version":"build-2803163510"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,28]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate whether trauma center level is associated with in-hospital mortality among patients undergoing operative management for spine trauma and to determine whether this relationship differs according to triage pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective cohort study was performed using the 2023 National Trauma Data Bank. Adult patients undergoing operative treatment for spine trauma at American College of Surgeons\u2013verified level I or level II trauma centers were identified. Patients with polytrauma or incomplete clinical data were excluded. Demographics, injury characteristics, comorbidities, arrival physiology, and hospital factors were compared between trauma center levels. Multivariable logistic regression models were constructed to assess the association between trauma center level and in-hospital mortality, stratified by triage pathway (direct admission vs interfacility transfer) and adjusted for demographic, injury severity, physiological, and hospital covariates. Significance was set at the p &lt; 0.05 level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 12,516 operative spine trauma encounters were included, with 8548 treated at level I centers and 3968 at level II centers. Level I centers managed patients with greater injury severity and higher comorbidity burden and received a larger proportion of interfacility transfers. Among directly admitted patients, treatment at a level I trauma center was associated with significantly lower adjusted odds of in-hospital mortality compared with level II centers (adjusted OR 0.62, 95% CI 0.39\u20130.97; p = 0.037). No significant mortality difference was observed among transferred patients (adjusted OR 0.88, 95% CI 0.47\u20131.68; p = 0.693).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Level I trauma center care was associated with reduced adjusted mortality among directly admitted operative spine trauma patients but not among transferred patients. These findings suggest that early access to specialized multidisciplinary spine trauma care, rather than trauma center designation alone, may drive improved survival and highlight the importance of optimized prehospital triage and direct transport strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.4.spine26178","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:01:37Z","timestamp":1787702497000},"page":"1-7","source":"Crossref","is-referenced-by-count":0,"title":["The association between direct admission to level I trauma centers and lower in-hospital mortality in operative spine trauma"],"prefix":"10.3171","author":[{"given":"Mitchell K.","family":"Ng","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas E.","family":"Mastrokostas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn;"},{"name":"Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G.","family":"Mastrokostas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn;"},{"name":"Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Inzerillo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jad","family":"Bou Monsef","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn;"},{"name":"Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshin E.","family":"Razi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas U.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Louisville, Kentucky; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Wilt","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark F.","family":"Kurd","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian David","family":"Kaye","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barrett","family":"Woods","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Fassett","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, AdventHealth, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, AdventHealth, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose A.","family":"Canseco","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Cha","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S.","family":"Hilibrand","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K.","family":"Kepler","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Int J Surg","first-page":"3827","article-title":"Traumatic spinal injury-related hospitalizations in the United States, 2016-2019: a retrospective study","volume":"109","author":"Sun J","year":"2023","unstructured":"Sun J, Yuan W, Zheng R,  Traumatic spinal injury-related hospitalizations in the United States, 2016-2019: a retrospective study. Int J Surg. 2023;109(12):3827\u20133835. doi:10.1097\/JS9.0000000000000696"},{"issue":"9","key":"b2","series-title":"Spine J","first-page":"1561","article-title":"The changing epidemiology of traumatic spine injuries: a trends analysis of 26 years of patients at a major level 1 trauma center in the United States","volume":"24","author":"Chiu AK","year":"2024","unstructured":"Chiu AK, Pease TJ, Prakash H,  The changing epidemiology of traumatic spine injuries: a trends analysis of 26 years of patients at a major level 1 trauma center in the United States. 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PLoS One. 2012;7(2):e32037. doi:10.1371\/journal.pone.0032037"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26178\/article-10.3171-2026.4.SPINE26178.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26178\/article-10.3171-2026.4.SPINE26178.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:40Z","timestamp":1788307240000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/aop\/article-10.3171-2026.4.SPINE26178\/article-10.3171-2026.4.SPINE26178.xml"}},"subtitle":["Presented at the 2026 AANS\/CNS Joint Section on Disorders of the Spine and Peripheral Nerves"],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":20,"URL":"https:\/\/doi.org\/10.3171\/2026.4.spine26178","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}