Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank.

BACKGROUND: To examine the efficacy of early versus late spinal fracture fixation, we reviewed National Trauma Data Bank (NTDB) records to identify the breakpoint in reported timing of operative fixation. Using this breakpoint we then analyzed outcome for those treated early versus late, hypothesizing that the early group would experience better outcome as reflected by resource utilization and complications. METHODS: The NTDB was queried for patients with any level spinal fracture that required surgical stabilization. Histogram analysis of the postinjury day of initial operative fixation was used to determine the point at which the majority of operative procedures had been performed, thereby defining early (E) and late (L) groups. Patients in E were matched to a cohort from L with similar age, Injury Severity Score, and Glasgow Coma Scale. Outcome data included hospital length of stay, intensive care unit length of stay, ventilator days, charges, incidence of complications, and mortality. The groups were compared using Student's t test for continuous variables and Fisher's exact test for categorical variables, accepting p < or = 0.05 as significant. RESULTS: Of 16,812 patients who underwent operative fixation, 59% were completed within 3 days of injury and formed E. The 374 L patients whose dataset was complete enough to allow analysis were matched to 497 E patients. There was no significant difference in the presence of spinal cord injury between E and L (51 vs. 48%; p = 0.3735). Complications were significantly higher in L (30% vs. 17.5%; p < 0.0001) yet mortality was similar in both groups (2.0% vs.1.9%; p > 0.05). CONCLUSIONS: NTDB records indicate that the majority of patients with spinal fractures undergo operative fixation within 3 days, and that these patients had less complications and required less resources. Use of a national data bank to compare groups with similar injury severity and presenting physiology can validate best practice and define opportunities for improvement in care.

The burden of noncompliance with seat belt use on a trauma center.

INTRODUCTION: It is well-known that noncompliance with seat belt use results in worse injury. The impact of noncompliance on hospital resource consumption and hospital charges is less well known. This study was carried out to examine the economic burden of noncompliance with seat belt use. METHODS: Trauma registry data were reviewed for patients involved in motor vehicle crashes in 2003 and 2004. Routine demographic data were analyzed. Outcome data included hospital length of stay, intensive care unit length of stay, number of ventilator days, and mortality. Hospital charges, rate of collection, hospital use (measured by need for admission), operating room use, and intensive care unit use were calculated to determine the burden of noncompliance with seat belt use. RESULTS: There were 3,426 patients identified for analysis. Of these patients, 1,744 (51%) were compliant with seat belt use (SEAT) while 1,682 were not compliant (NO SEAT). Patients in the NO SEAT group were significantly younger (31.2 versus 37.4 years old) and significantly more severely injured (Injury Severity Score of 11 versus 7) than those in the SEAT group. Patients in the NO SEAT group had a significantly longer hospital length of stay (4.4 versus 2.2 days) and intensive care unit length of stay (1.4 versus 0.3 days), as well as significantly more ventilator days (1.2 versus 0.2 days) than those in the SEAT group. Mortality was more than doubled in the NO SEAT group (2.2 versus 0.9%) as compared with the SEAT group. Resource consumption was significantly greater in the NO SEAT group, as evidenced by increased hospital use (64.9 versus 39%), increased critical care unit use (22.9 versus 10.3%) and increased operating room use (9.2 versus 4.9%) when compared with the SEAT group. Subsequently, hospital charges were significantly higher in the NO SEAT group ($32,138 versus $16,547) than in the SEAT group. Charge collection rate was lower in the NO SEAT group (30.5 versus 42.5%) than in the SEAT group. CONCLUSIONS: These data quantify the burden placed on a trauma center by noncompliance with seat belt use. This information should drive more focused education and injury prevention programs. It should also be clearly articulated to legislators to stimulate more support for more stringent legislative policy and improved trauma center funding.