Are there missed warning signals before traffic-related traumatic spinal cord injury? An exploratory case-control study using electronic health records.

BACKGROUND

Traumatic spinal cord injury (TSCI) is a catastrophic outcome frequently resulting from road-traffic crashes. We investigated whether routinely recorded pre-injury healthcare utilization patterns in electronic health records (EHRs) can serve as pragmatic warning signals for TSCI among drivers and motorcyclists.

METHODS

We conducted a retrospective age- and sex-matched case-control study using national EHR data. Adults aged 18-45 years with traffic-accident-related TSCI as drivers or motorcyclists (2024-2025) were matched 1: 1 with controls (n=35 per group). Pre-index utilization during the preceding 24 months included trauma-related emergency department (ED) visits, orthopedics/traumatology department (OTD) visits, total trauma-related visits, and psychiatry visits. Between-group comparisons used Mann-Whitney U tests. Receiver operating characteristic analyses were used to summarize discriminative performance. Binary risk flags (≥1 ED visit; ≥1 psychiatry visit) were evaluated using multivariable logistic regression.

RESULTS

The analytic sample included 70 participants. Compared with controls, TSCI cases had higher trauma-related ED visits (p<0.001; r=0.45), psychiatry visits (p=0.010; r=0.31), and total trauma-related visits (p=0.035; r=0.25), whereas OTD visits did not differ (p=0.920). ED visits showed the highest discrimination (area under curve [AUC]=0.726). In this sample, the ≥1 versus 0 contrast yielded sensitivity 60.0% and specificity 82.9%. Psychiatry visits showed modest discrimination (AUC=0.649). In this sample, the ≥1 versus 0 contrast yielded sensitivity 45.7% and specificity 80.0%. In multivariable analysis, ≥1 ED visit (odds ratio [OR]=8.85, 95% confidence interval [CI] 2.68-29.23; p<0.001) and ≥1 psychiatry visit (OR=4.52, 95% CI 1.34-15.20; p=0.015) were independently associated with TSCI.

CONCLUSION

Traffic-related TSCI may be preceded by measurable pre-injury patterns - particularly trauma-related ED utilization and psychiatry visits - captured in routinely collected EHR data. These findings support a pragmatic risk-flagging approach that may help identify individuals who could benefit from targeted preventive education, injury-risk counseling, and psychosocial risk-reduction interventions. These findings should be interpreted with caution and require validation in larger prospective studies.