Impact of a quality improvement program on the neurological outcome of patients with traumatic spinal cord injury. A before-after mono-centric study.

Spine Cord Injury (SCI) is a major cause of severe disability. This study aims to assess the effectiveness of a quality improvement program on neurological recovery after SCI. Before-after study during two phases in one intensive care unit in a University Hospital. The quality improvement project comprised protective mechanical ventilation, early tracheostomy in anatomical injury above the 6th cervical vertebra, early enteral nutrition, early mobilization and active perineal care, in adult SCI patients. Primary endpoint was the difference between the ASIA motor score between discharge and ICU admission (Delta ASIA). Fifty-seven and 60 patients were included in the control and in the intervention period respectively. The ASIA motor score upon ICU admission was 16 (7-37) before and 11 (2-30) after the implementation (p=0.30). The implementation phase was associated with lower tidal volumes (p<0.001), higher PEEP (p<0.001), earlier tracheostomy (p=0.01), earlier enteral nutrition initiation (p<0.05), earlier...