Timing of surgery for children and adolescents sustaining complete traumatic spinal cord injury
Bibliographic record
Abstract
OBJECTIVE: Spinal cord injury (SCI) trials have historically underrepresented pediatric patients. There are limited pediatric data examining the influence of surgical timing on complications and mortality for children and adolescents who have sustained complete traumatic SCI. METHODS: The following multicenter cohort study used Trauma Quality Improvement Program data from 2010 to 2020. The authors identified pediatric patients (aged < 18 years) who sustained complete traumatic SCI and underwent surgical intervention within 7 days of admission. Propensity score matching was performed between patients who underwent surgery within 24 hours versus ≥ 24 hours. The authors then assessed differences for the following outcomes: major in-hospital complications, immobility-related complications, length of stay (LOS), and mortality. RESULTS: There were 837 patients with complete traumatic SCI managed across 297 trauma centers identified for study inclusion (70% underwent early surgery). After matching, 494 patients were available for analysis. Patients undergoing delayed surgery experienced longer ICU LOS (mean difference 3.74 days, 95% CI 0.91-6.57 days) and more major in-hospital complications (OR 1.77, 95% CI 1.16-2.73) and immobility-related complications (OR 2.09, 95% CI 1.25-3.56). There were no differences in mortality between groups. Younger age, non-White race, penetrating injuries, lower Glasgow Coma Scale score at admission, severe concomitant abdominal injuries, and motor vehicle collision injury mechanisms were associated with increased time to surgery. CONCLUSIONS: The authors demonstrated an association between early surgery and shorter ICU LOS and reduced in-hospital complications. Future work is needed to quantify the impact of surgical timing on functional neurological outcomes and to explore upstream social determinants of health influencing timing of surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".