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Patients with serious spinal cord injuries (SCIs) usually have other life-threatening injuries, and those presenting to non-specialized centers should be stabilized and treated for concomitant life-threatening injuries expeditiously. Utilizing the resources of trauma networks, an early transfer to an appropriate center with SCI expertise should be arranged to reduce the risk of death (Dvorak, J Neurotrauma 40:2638–2647, 2023). Trauma systems were first introduced in the United States in the early 1970s to regionalize care for traumatic injuries to allow for an organized approach to injury management (American College of Surgeons, Committee on Trauma, Resources for optimal care of the injured patient. American College of Surgeons, Committee on Trauma, 1990). Since then, institutions within trauma systems have played an integral role in providing timely and appropriate care to patients with severe injuries, including SCIs. The National Study on the Costs and Outcomes of Trauma (NSCOT) showed that the mortality risk is significantly lower when care is provided at a Level I trauma center compared to a non-trauma center (MacKenzie, N Engl J Med 354:366–378, 2006). SCIs are complex traumatic insults that can result in devastating lifelong impairments, including a significantly increased risk of death (Chamberlain, Neuroepidemiology 44:182–198, 2015). The complex nature of SCIs may warrant advanced care delivered at hospitals with specialized SCI expertise. A trauma network comprised of hospitals designated at different levels based on their capability will provide specialized care for acute injuries. Level I and Level II trauma centers in a trauma network have SCI expertise (Soto, Chin J Traumatol 21:77–79, 2018). In a retrospective analysis of 1920 patients with SCI, the unadjusted risk of death from SCI was significantly lower among patients cared for at specialized compared to non-specialized hospitals at 1 year (Dvorak, J Neurotrauma 40:2638–2647, 2023). In this chapter, we will cover the pathophysiology and management of SCIs in the context of trauma networks and neurocritical care specialization.

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Role of Trauma Networks and Neurocritical Care Specialization in the Treatment of Spinal Cord Injury

  • 章节

  • 发表日期：

    2025年

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  • Umar F. Bhatti,
  • Ara Ko

摘要

Patients with serious spinal cord injuries (SCIs) usually have other life-threatening injuries, and those presenting to non-specialized centers should be stabilized and treated for concomitant life-threatening injuries expeditiously. Utilizing the resources of trauma networks, an early transfer to an appropriate center with SCI expertise should be arranged to reduce the risk of death (Dvorak, J Neurotrauma 40:2638–2647, 2023). Trauma systems were first introduced in the United States in the early 1970s to regionalize care for traumatic injuries to allow for an organized approach to injury management (American College of Surgeons, Committee on Trauma, Resources for optimal care of the injured patient. American College of Surgeons, Committee on Trauma, 1990). Since then, institutions within trauma systems have played an integral role in providing timely and appropriate care to patients with severe injuries, including SCIs. The National Study on the Costs and Outcomes of Trauma (NSCOT) showed that the mortality risk is significantly lower when care is provided at a Level I trauma center compared to a non-trauma center (MacKenzie, N Engl J Med 354:366–378, 2006). SCIs are complex traumatic insults that can result in devastating lifelong impairments, including a significantly increased risk of death (Chamberlain, Neuroepidemiology 44:182–198, 2015). The complex nature of SCIs may warrant advanced care delivered at hospitals with specialized SCI expertise. A trauma network comprised of hospitals designated at different levels based on their capability will provide specialized care for acute injuries. Level I and Level II trauma centers in a trauma network have SCI expertise (Soto, Chin J Traumatol 21:77–79, 2018). In a retrospective analysis of 1920 patients with SCI, the unadjusted risk of death from SCI was significantly lower among patients cared for at specialized compared to non-specialized hospitals at 1 year (Dvorak, J Neurotrauma 40:2638–2647, 2023). In this chapter, we will cover the pathophysiology and management of SCIs in the context of trauma networks and neurocritical care specialization.