Factors Associated with Delayed Presentation Following Spinal Cord Injury

Introduction: Timely presentation to acute care is critical for optimal outcomes in spinal cord injury (SCI) patients. This study aims to identify factors associated with delayed presentation among adult SCI patients.

Methods: We analyzed 5,031 adult patients from the National Spinal Cord Injury Model Systems (SCIMS) Database from 2011 to 2021. The outcome variable, time to acute care presentation, was categorized as 1 day (n=1,819), 2-7 days (n=522), 8-14 days (n=1,121), 15-30 days (n=926), and 31+ days (n=643). Due to significant skewness and bimodality in the outcome distribution, multivariable ordinal regression was employed. Covariates included demographics, body mass index (BMI), income level, neurological region of injury, injury etiology, concomitant non-spinal injuries, and vertebral injury.

Results: The mean age was 42.6 (standard deviation [SD] = 17.6) years, with 19.9% female and 69.8% white participants; 42.8% had American Spinal Injury Association [ASIA] Impairment Scale (AIS) Grade A injuries, and 59.2% had cervical injuries. Increasing age was significantly associated with shorter presentation times (adjusted odds ratio [aOR]=0.994, 95% confidence interval [CI] [0.991-0.998], p=0.001). Lower BMI was also associated with delayed presentation (aOR=0.98, 95%CI [0.97-0.99], p< 0.001). Higher income levels of $50,000–$74,999 (aOR=1.36, 95%CI [1.14-1.63], p< 0.001) and $75,000+ (aOR=1.45, 95%CI [1.24-1.71], p< 0.001) were linked to increased delays, compared to incomes below $25,000. Thoracic (aOR=0.75, 95%CI [0.67-0.85], p< 0.001) and lumbar (aOR=0.55, 95%CI [0.45-0.66], p< 0.001) injuries were associated with reduced delays, compared to cervical injuries. Falls (aOR = 0.83, 95%CI [0.73-0.94], p = 0.003) and violence-related injuries (aOR = 0.79, 95%CI [0.66-0.95], p = 0.011) were significantly associated with longer delays in care. Concomitant non-spinal injuries increased the odds of delayed presentation (aOR=1.74, 95%CI [1.56-1.95], p< 0.001).

Conclusion : Age, BMI, income level, neurological injury region, injury mechanism, and concomitant non-spinal injuries significantly influence the timing of acute care presentation in SCI patients. These findings can inform targeted interventions to reduce delays and improve outcomes in this population.