035 - Timing of surgical intervention for children sustaining complete traumatic spinal cord injury.

Publication Number: 35.6572

Ahad Jassani, Royal College of Surgeons Ireland, Dublin, Dublin, Ireland; Armaan Malhotra, University of Toronto, Toronto, ON, Canada; Ahmad Essa, St. Michael, israel, HaMerkaz, Israel; Husain Shakil, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Jetan H. Badhiwala, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Jennifer Quon, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; George M. Ibrahim, The Hospital for Sick Children, Toronto, ON, Canada; Jennifer A. Dermott, The Hospital for Sick Children, Toronto, ON, Canada; David E Lebel, University of Toronto, Toronto, ON, Canada; Abhaya V.. Kulkarni, Hospital for Sick Children, Toronto, ON, Canada; Avery Nathens, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Jefferson Wilson, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Christopher Witiw, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada

Background: Existing spinal cord injury (SCI) trials that demonstrated the importance of surgical timing for neurological outcomes have historically underrepresented pediatric patients. There is lacking data examining the influence of surgical timing on in-hospital complications and mortality for children with complete SCI. Further, the patient characteristics, injury factors and secular trends associated with timing of surgery for pediatric SCI remain unknown.

Objective: The primary objective was to assess the association between early ( < 24h) vs. delayed (>24h) surgery for traumatic SCI and in-hospital complications, immobility complications, mortality, and length of stay. Secondary objectives included identifying factors influencing surgery rates and trends in timing over the past decade, focusing on two key advances: the STASCIS trial (2012) and 2017 guidelines recommending early surgery.

Design/Methods: This retrospective multicenter cohort study used data from the American College of Surgeons Trauma Quality Improvement Program (2010-2020). We identified children with complete traumatic SCI who underwent surgery within 7 days. Propensity score matching was used to compare early ( < 24h) vs. delayed (>24h) surgery. Logistic and linear regression analyzed complications, LOS, and mortality, while secondary analyses explored surgery rates and patient characteristics.

Results: A total of 837 patients with complete traumatic SCI from 297 trauma centers were included. After propensity score matching, 494 patients who underwent early ( < 24h) or delayed (>24h) surgery were analyzed. Early surgery was associated with shorter ICU stays (3.74 days, 95% CI: 0.91-6.57), fewer major complications (OR 1.77, 95% CI: 1.16-2.73), and fewer immobility-related complications (OR 2.09, 95% CI: 1.25-3.56), but no difference in mortality. Factors linked to delayed surgery included younger age, non-white race, penetrating injuries, lower Glasgow Coma Scale score, severe abdominal injuries, and motor vehicle collisions. Surgical timing improved later in the study, likely due to evidence supporting early surgery for neurological recovery.

Conclusion(s): We found that early surgery for children with complete traumatic SCI was associated with shorter ICU stays, fewer major in-hospital complications, and reduced immobility-related complications. Patient and injury factors were linked to surgical timing. Over the decade, time to surgery decreased, especially from 2017-2020. Future prospective studies are needed to assess the impact of surgical timing on long-term neurological outcomes in children, similar to findings in adult SCI patients.