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Merritt et al. Neuroimmunol Neuroinflammation 2019;6:9 I http://dx.doi.org/10.20517/2347-8659.2019.15 Page 3 of 11

[2]
Figure 1. A pie chart illustrating the major causes of TSCI since 2010 according to the NSCISC. The NSCISC estimates that the most
common causes of TSCI include motor vehicle accidents (blue), mechanical falls (orange), and acts of violence (gray). Less commonly
TSCI is caused by sports-related injuries (yellow), medical/surgical causes (pink), and other miscellaneous causes not previously listed
(green). TSCI: traumatic spinal cord injury; NSCISC: National Spinal Cord Injury Statistical Center

Table 1. Percentage of patients with ASIA grade at ER discharge and resultant one year ASIA improvements
TSCI patients with ASIA ASIA Grade one year improvement
ASIA Grade Injury type Definition Of ASIA Grade
Grade at time of Discharge* rates (≥ 1 Grade level)**
Grade A Complete Complete sensorimotor loss 36.4% 25.1%
Grade B Incomplete Complete motor loss with incomplete 13.8% 71.1%
sensory loss
Grade C Incomplete Motor function is preserved, but more than 11.9% 78.8%
50% of key muscles below the neurological
level have a muscle grade < 3
Grade D Incomplete Motor function is preserved but the at 37.6% 14.1%
least 50% of key muscles below the
neurological level have a muscle grade ≥ 3
Grade E Normal Motor and sensory functions are normal 0.3% N/A
ASIA: American spinal injury association; *: within each of the ASIA grade rows, there is the percentage of total TSCI patients at the time
of hospital discharge with that specific ASIA grade injury out of all TSCI patients; ER: emergency room; TSCI: traumatic spinal cord injury;
**: percentage of patients who have improved ≥ 1 ASIA grades from their original ASIA grade assignment (column 1) at one year post-
discharge. Grade B and C injuries have the highest chance of improvements at 71.1% and 78.8%, respectively [26,27]

Evidence demonstrates that surgical intervention within the first 72 h post-injury is both a key prognostic
and cost-determining factor in the context of TSCI. Surgical intervention within this crucial window has
been shown to directly correlate with a decreased hospital length of stay (LOS) and subsequent decreased
medical costs [15,16] . If surgical intervention is received within 72 h following the initial injury, hospitals
were found to save an average of $14,000 on resource utilization. Additionally, patients were found to
have a greater chance of neurological recovery and were spared approximately $45,000 in medical costs.
A prospective cohort study investigating the relationship between the delay of surgical decompression
following TSCI and neurological recovery found that decompression within the first 24 h more than
doubled the chance of recovery of a 2 ASIA grade TSCI as compared to those who received spinal cord
decompression outside of this 24 h window [15,17] . This rapid surgical turnaround within 24 h was found to
be just as safe . However, this crucial window presents an access to care issue for those living in rural
[18]
areas in which there is a high prevalence of TSCI, but low rate of hospitalization with subsequent inflated