Global Neurotrauma Outcomes Study: Spine (GNOS Spine)

Primary aim:

Characterise case-mix, processes of care and variations in nonoperative and operative management strategies, including emergency, ward, surgical and ICU care, in patients presenting with traumatic spinal injury (TSI) between centres across low and high Human Development Index (HDI) countries.

Primary outcome measure:

The primary outcome measure will be Frankel Grade at 6 weeks post-admission (or discharge, whichever comes first).

Primary comparison:

Between country groups defined by human development index

Centre eligibility:

Any unit assessing patients with TSI worldwide will be eligible to participate

Patient eligibility:

All adult patients presenting with radiologically confirmed traumatic spinal injury.

Team:

Each participating unit will form a study team of up to four investigators including a study lead, local investigator 1/2 and an independent data validator.

Time period:

Local study teams may select any 30-day period from July 12th 2021 to start their study. Patients who meet the inclusion criteria between 00:01 on day 0 and 23:59 on day 30 of the selected study period will be included.

Validation:

There will be a two-phase data validation process. Phase 1 will be prospective, validating case ascertainment, and phase 2 will be retrospective, validating operative data.

Study Overview

• Status: Recruiting
• Conditions: Trauma; Spine Injury
• Intervention / Treatment: Other: Exposure

Detailed Description

Background Traumatic spinal injury (TSI) accounts for a significant proportion of disability and death worldwide, with the majority of this burden affecting individuals in low- to middle- income countries. Crucially, to date, the current disease profile of TSI has not been characterised globally. In addition, the global approach to the care of patients following TSI is inconsistent with considerable geographical differences in process of care reported, and limited data available on the impact of these variations on outcomes following TSI. A better understanding of case-mix and processes of care is urgently needed to underpin efforts to identify ways of improving outcome relevant to different socioeconomic settings globally.

Objectives The primary objective of this study is to characterise the case-mix, processes of care and variations in nonoperative and operative management strategies, including emergency, ward, ICU care, in patients presenting with traumatic spinal injury (TSI) between centres across low and high Human Development Index (HDI) countries. The secondary aims are to summarise current local resources and management pathways for TSI through validation of provider profiling data, describe differences in indications for nonoperative and operative management, and short-term outcomes following TSI. This study aims to identify gaps in processes of care to identify targets for future interventions to improve TSI care across high and low-resource settings.

Methods A multi-centre, international, prospective, observational study. Any unit assessing patients with TSI worldwide will be eligible to participate. Each participating unit will form a study team responsible for gaining local approval, identifying patients for inclusion and conducting data collection. Data will be collected via a secure online platform in an anonymised form. Processes of care will be characterised by a detailed provider profiling exercise. A registry describing the case-mix and care of all adults presenting with radiologically confirmed TSI will be collected, in a given consecutive 30-day period during the study period starting in 2021.

Results The dataset, developed through an iterative feedback process involving clinicians from low and high Human Development Index (HDI) countries, includes patient demographics, details of injury mechanism, local injury management and, if applicable, timing and nature of surgery, post-operative care and immediate postoperative complications. Outcome measures include Frankel grade at 6 weeks post-admission (or at discharge or death, whichever event occurs first), early mortality, peri-operative complications, adverse events of special interest, functional status and mobility. Descriptive analyses of case-mix and the variations in processes of care will be conducted. Available resources, use of guidelines and variations in processes of care will be characterised using both provider profiling responses and patient-level data collected. Areas where known best practice is deficient or unavailable will be identified as potential targets for future implementation studies.

Conclusions GNOS Spine aims to provide a global snapshot of the case-mix, management, processes of care and short-term outcomes of patients presenting with TSI. In addition, the study aims to identify areas for further study, and establish a platform and clinical network to facilitate this future research in global neurotrauma and spinal surgery.

• Study Type: Observational
• Enrollment (Estimated): 1000

Contacts and Locations

• Study Contact: Name: Saniya Mediratta; Phone Number: +441223336946; Email: info@globalspinetrauma.com
• Study Contact Backup: Name: Rikin Trivedi; Phone Number: +441223336946; Email: info@globalspinetrauma.com

Study Locations

• United Kingdom
  • County
    • Cambridge, County, United Kingdom
      • Recruiting
      • University of Cambridge
      • Contact: Saniya Mediratta

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All adult patients with radiologically confirmed traumatic spine injury

Description

Centre inclusion Criteria

• Any primary, secondary or tertiary institution worldwide managing patients with TSI is eligible to participate.
• In many institutions, management for TSI may be provided by spinal surgeons - however, centres in which management for TSI is provided by general surgeons, trauma surgeons, general medical doctors or even non-physician clinicians are also eligible to participate.

Patient inclusion and exclusion criteria Inclusion Criteria

• All adult patients presenting to the participating institution with a first presentation of TSI confirmed radiographically, during the selected 30-day inclusion period are eligible for inclusion in the core study.

Exclusion Criteria

• Elective (planned) or semi-elective (patient initially discharged after emergency with planned
• intervention at a future date) admissions
• Patients who have previously had an admission for TSI rendering them eligible for inclusion in this study (regardless of whether they were included on the previous admission or not)

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Radiologically confirmed traumatic spine injury	Other: Exposure; Human Development Index of Country

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frankel Grade	A = complete motor and sensory loss (poor outcome), E = no neurological symptoms or signs (good outcome)	At discharge or 6 weeks post-admission, whichever comes first

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality	Assessment of survival	At discharge or 6 weeks post-admission, whichever comes first
Length of Stay	Hospital and ICU	At discharge or at 6 weeks post-admission (whichever comes first)
Peri-operative Complications	Return to operating theatre, surgical site infections, adverse events of special interest (pressure ulcer, pneumonia, DVT)	At discharge or at 6 weeks post-admission (whichever comes first)
Independence with activities of daily living (ADLs)	Rating of specific ADLs as unaided, with aid or completely dependent	At discharge or at 6 weeks post-admission (whichever comes first)
Mobility	Mechanism of mobility e.g. mobilising independently, mobilising with a frame, wheelchair, bed bound etc.)	At discharge or at 6 weeks post-admission (whichever comes first)

Collaborators and Investigators

• Sponsor: University of Cambridge
• Collaborators: NIHR Global Health Research Group on Neurotrauma
• Investigators: Principal Investigator: Saniya Mediratta, NIHR Global Health Research Group on Neurotrauma; Principal Investigator: Jibin Francis, NIHR Global Health Research Group on Neurotrauma; Principal Investigator: Peter Hutchinson, NIHR Global Health Research Group on Neurotrauma; Principal Investigator: Rikin Trivedi, NIHR Global Health Research Group on Neurotrauma

Study record dates

Study Major Dates

• Study Start (Actual): July 12, 2021
• Primary Completion (Estimated): May 30, 2023
• Study Completion (Estimated): May 30, 2023

Study Registration Dates

• First Submitted: March 5, 2023
• First Submitted That Met QC Criteria: May 21, 2023
• First Posted (Actual): June 1, 2023

Study Record Updates

• Last Update Posted (Actual): June 1, 2023
• Last Update Submitted That Met QC Criteria: May 21, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Traumatic spine injury; Global burden
• Additional Relevant MeSH Terms: Wounds and Injuries; Back Injuries; Spinal Injuries
• Other Study ID Numbers: GNOSSpine

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After publication of the main results, the pooled dataset will be available to all members of the GNOS Spine collaboration for secondary analysis, after judgement and approval of each proposed analysis by the central study team.
• IPD Sharing Time Frame: Following publication of the main results
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No