Rates of nonoperative management and secondary overtriage in patients with spine fracture transferred to level I or II trauma centers.

Abstract

Traumatic spine fractures are common in trauma patients, and with an aging population, the incidence of spine fractures will continue to increase. However, wide variability in injury severity can lead to unnecessary transfers to higher-level trauma centers (TCs), potentially resulting in the overuse of healthcare resources. The primary objective of this study was to assess the rate of nonoperative management and the extent of secondary overtriage (SOT) among patients with traumatic spine fractures. The secondary objective was to identify patient and hospital factors associated with SOT. This retrospective observational cohort study used data from between 2017 and 2020 from the American College of Surgeons Trauma Quality Improvement Program database. The study included adult patients with traumatic spine fractures who had been transferred to level I (LI) or level II (LII) TCs. Patients with multisystem polytrauma and spinal cord injuries were excluded. The primary outcome was the rate of SOT among the patients, and secondary outcomes included factors associated with SOT, which were identified using mixed-effects logistic regression. A total of 29,591 patients from 629 centers were analyzed. Most of the patients were managed nonoperatively (n = 24,007, 81.1%), with a high rate of SOT (18.2%). Patients with spine fractures who were less likely to experience SOT included those with lumbar spine fractures (OR 0.75, 95% CI 0.69-0.82, p < 0.001) and an age over 60 years (OR 0.42, 95% CI 0.39-0.46, p < 0.001). There was significant variability in center-dependent rates of early discharge and interfacility transfer, but this variance appeared to be unaffected by patient volume. The current pattern of care for patients with traumatic spine fracture includes high proportions of nonoperatively managed patients and those who undergo SOT. Optimizing triage protocols, particularly for older patients and those with lumbar spine fractures, may reduce unnecessary transfers and improve healthcare resource utilization.