Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

Ramos, Rafael De la Garza; Park, Christine; McCray, Edwin; Price, Meghan; Wang, Timothy Y.; Dalton, Tara; Baëta, César; Erickson, Melissa; Foster, Norah; Pennington, Zach; Shin, John H.; Sciubba, Daniel M.; Than, Khoi D.; Karikari, Isaac O.; Shaffrey, Christopher I.; Abd-El-Barr, Muhammad M.; Yassari, Reza; Goodwin, C. Rory

doi:10.3171/2021.2.focus201085

Cited by 7 publications

(2 citation statements)

References 38 publications

(37 reference statements)

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“…Of the patients who were admitted emergently, almost half did not undergo surgery during that admission and the cost of the emergent care was significantly higher than the cost of planned admissions. 13 Similarly, de la Garza Ramos et al 15 demonstrated that patients with metastatic spinal disease who were transferred between hospitals had significantly more severe clinical presentations and higher rates of inpatient complications compared to patients directly admitted through clinics. Both studies support the idea that care managed through a multidisciplinary spinal oncology clinic, which coordinates and streamlines care, can provide improved and less costly care for patients and hospital systems.…”

Section: Discussionmentioning

confidence: 99%

Patients with progression of spinal metastases who present to the clinic have better outcomes compared to those who present to the emergency department

Linzey,

Kathawate,

Strong

et al. 2023

Cancer Medicine

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BackgroundAs cancer therapies have improved, spinal metastases are increasingly common. Resulting complications have a significant impact on patient's quality of life. Optimal methods of surveillance and avoidance of neurologic deficits are understudied. This study compares the clinical course of patients who initially presented to the emergency department (ED) versus a multidisciplinary spine oncology clinic and who underwent stereotactic body radiation therapy (SBRT) secondary to progression/presentation of metastatic spine disease.MethodsWe performed a retrospective analysis of a prospectively maintained database of adult oncologic patients who underwent spinal SBRT at a single hospital from 2010 to 2021. Descriptive statistics and survival analyses were performed.ResultsWe identified 498 spinal radiographic treatment sites in 390 patients. Of these patients, 118 (30.3%) presented to the ED. Patients presenting to the ED compared to the clinic had significantly more severe spinal compression (52.5% vs. 11.7%; p < 0.0001), severe pain (28.8% vs. 10.3%; p < 0.0001), weakness (24.5% vs. 4.5%; p < 0.0001), and difficulty walking (24.5% vs. 4.5%; p < 0.0001). Patients who presented to the ED compared to the clinic were significantly more likely to have surgical intervention followed by SBRT (55.4% vs. 15.3%; p < 0.0001) compared to SBRT alone. Patients who presented to the ED compared to the clinic had a significantly quicker interval to distant spine progression (5.1 ± 6.5 vs. 9.1 ± 10.2 months; p = 0.004), systemic progression (5.1 ± 7.2 vs. 9.2 ± 10.7 months; p < 0.0001), and worse overall survival (9.3 ± 10.0 vs. 14.3 ± 13.7 months; p = 0.002).ConclusionThe establishment of multidisciplinary spine oncology clinics is an opportunity to potentially allow for earlier, more data‐driven treatment of their spinal metastatic disease.

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Section: Discussionmentioning

confidence: 99%

Patients with progression of spinal metastases who present to the clinic have better outcomes compared to those who present to the emergency department

Linzey,

Kathawate,

Strong

et al. 2023

Cancer Medicine

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“…A recent study that examined interhospital referrals for patients with spinal metastasis stated that some hospitals lack resources and request referrals to specialized centers ( 7 ). Still, the decision to refer the patient to another hospital must outweigh the risks of delay in proper medical treatment ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Pediatric TBI: Direct admissions vs. secondary referrals to a hospital: A single‑center, retrospective study

Allawati,

Al‑Kindi,

Al Jaadi

et al. 2024

Med Int

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The present retrospective study was conducted in an aim to examine the differences between pediatric traumatic brain injury (TBI) cases referred to and those admitted directly to the hospital. For this purpose, pediatric patients who presented to a main trauma center with TBI between January, 2015 and December, 2019 were reviewed retrospectively, emphasizing whether they were admitted directly or referred from another center. Data collected included the demographic characteristics of the patients, as well as their presenting complaints and the cause of TBI. A total of 981 cases of pediatric TBI were admitted over the 5-year period. The average age of the patients was 58.1 months for the referred cases and almost 50 months for the patients directly admitted. The male sex accounted for 63.6% of all cases. The most common cause of injury was falling (63.5%). Nausea and vomiting were the most typical presenting symptoms, occurring more among the directly admitted cases (P-value ≤0.05). Mild TBI accounted for 85.3% of the cases, and the most common radiological diagnosis was skull fracture (37.4%) (P-value ≤0.004). The referred patients had a more extended hospital stay (P-value ≤0.001). On the whole, the present study identified 981 cases; the majority of these were direct admissions, and the majority of the severe cases were referred from other healthcare facilities. Further research is required on this topic as only a single hospital was covered herein, and patients were not followed-up after discharge. A multi-center analysis would cover a greater number of patients and would thus provide more substantial data on the topic.

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Interhospital transfer of patients with malignant brain tumors undergoing resection is associated with routine discharge

Han

Yuan

Bonney

et al. 2022

Clinical Neurology and Neurosurgery

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Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

Cited by 7 publications

References 38 publications

Patients with progression of spinal metastases who present to the clinic have better outcomes compared to those who present to the emergency department

Patients with progression of spinal metastases who present to the clinic have better outcomes compared to those who present to the emergency department

Pediatric TBI: Direct admissions vs. secondary referrals to a hospital: A single‑center, retrospective study

Interhospital transfer of patients with malignant brain tumors undergoing resection is associated with routine discharge

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