Trends in the treatment for traumatic central cord syndrome without bone injury in the United States from 2000 to 2009

Abstract

Background: Treatment for traumatic central cord syndrome (TCCS) without bone injury is still controversial. The purpose of this study was to examine trends in the treatment for TCCS without bone injury in the United States.

Methods: Clinical data were obtained from the US Nationwide Inpatient Sample from 2000 to 2009. Patients with TCCS without bone injury were identified and divided into those receiving surgical treatment and those receiving conservative treatment according to the International Classification of Diseases-9th Rev.-Clinical Modification codes. Patient and health care system-related demographic data were retrieved. Trends in the treatment and patient outcomes were analyzed. Multivariate logistic regression analysis was then performed to identify the predictors for surgical treatment.

Results: The ratio of patients who underwent surgical treatment was 27.1%. This ratio increased from 14.8% in 2000 to 30.5% in 2009 (p = 0.008). A total of 47.2% of surgical procedures were performed between Days 0 and 2. Multivariate analysis revealed that larger hospital size was a significant predictor for surgical treatment and patients who received treatment in Northeastern region were less likely to undergo surgical treatment. Comparisons between patients receiving surgical and conservative treatment revealed that those receiving surgical treatment had significantly higher overall in-hospital complication rate (18.6% vs. 14.5%), lower pulmonary embolism rate (0.5% vs. 1.2%), lower in-hospital mortality rate (2.0% vs. 2.7%), longer hospital stays (11.2 days vs. 9.9 days), and increased total hospital costs ($93,940 vs. $50,701).

Conclusion: The ratio of patients who underwent surgical treatment for TCCS without bone injury increased from 2000 to 2009. Approximately half of surgical procedures were performed from Days 0 to 2. Patients who received treatment in a small hospital or the Northeastern region were less likely to undergo surgical treatment. Although the overall in-hospital complication rate was higher in patients with surgical treatment, pulmonary embolism and in-hospital mortality rates were higher in patients with conservative treatment than those in patients with surgical treatment.

Level of evidence: Prognostic and epidemiologic study, level III. Therapeutic study, level IV.