Analysis of prehospital care and emergency room treatment of patients with acute traumatic spinal cord injury: a retrospective cohort study on the implementation of current guidelines

Kreinest, Michael; Ludes, L; Türk, Ansgar; Grützner, Paul Alfred; Biglari, Bahram; Matschke, Stefan

doi:10.1038/sc.2016.84

Cited by 16 publications

(21 citation statements)

References 31 publications

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“…Whereas historical trials show no benefit to early (< 24 hours from time of injury) surgical intervention, more recent studies report improved motor and neurological recovery. 46 Notably, the prospective multicenter Surgical Timing in Acute Spinal Cord Injury Study trial conducted from 2002 to 2009 reports improved AIS grades among patients with acute cervical SCI who underwent early versus late surgery. 27 This is supported by the systematic review by Lenehan and colleagues showing improved odds of 6-and 12-month functional outcome following early surgery.…”

Section: Surgical Timingmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.

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Section: Surgical Timingmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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“…In Ahidjo's study, M/F ratio was 7.8:1 [20]. In Kreinest's study, M/ F was 3.58:1 [19]. In Oteir's study, the male to female ratio varied from 1.6:1 in an Irish study to 6:1 in a study in New South Wales Australia [23].…”

Section: Discussionmentioning

confidence: 87%

“…In Miekisiak's study, out of 108 patients, 70 were 45 years or younger and 38 were more than 45 years old [18]. In a study conducted by Kreinest and colleagues, the Mean±SD age of patients was 50.5±21.2 [19]. In Ahidjo's study, the mean age of patients was 36.4±12.7 [20].…”

Section: Discussionmentioning

confidence: 95%

“…Complete immobilization was performed in nearly half (56.7%) of the patients, and 20% of patients were not immobilized in any way. Only one patient who was not immobilized suffered from severe associated injuries and hemodynamic instability caused by hemorrhagic shock [19]. In McDonald's study, 66 of 1129 patients (6.73%) were immobilized in the pre-hospital settings.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Pre-hospital Emergency Services, Non-Surgical Interventions, and Clinical Outcomes in Patients With Traumatic Spine

Andalib

Mohtasham-Amiri

Yousefzadeh-Chabok

et al. 2019

Iran. J. Neurosurg.

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Background and Aim:The aim of this study was to assess the pre-hospital emergency services, non-surgical interventions, and clinical outcomes in patients with traumatic spine referred to Poursina hospital in Guilan. Methods and Materials/Patients: Spine trauma registry of Poursina hospital of Rasht were used. Records of patients with traumatic spine were reviewed for pre-hospital emergency services, nonsurgical interventions, and clinical outcomes during 2015 to 2019.Results: 197 patients with traumatic spine were reviewed. 80.2% of the patients were transferred by ambulance. Pre-hospital fixation was performed in 59.4% of the patients (n=117). Pre-hospital intubation was required in 1% of patients (n=2). 4.6% of the patients had Glasgow Comma Scale (GCS) <9; 3% of them (n=6) had 9< GCS<12; and 92.4% had GCS≥13. 11.7% of the patients experienced SCI. 6.1%, 1%, 3%, 0.5%, and 1% of the patients suffered from paraplegia, paraparesis, quadriplegia, quadriparesis, hemiparesis, respectively. Surgery was performed in 89.8% of the patients. Traction was performed for 3.6% of the patients. Good recovery, moderate disabilities, severe disabilities, persistent vegetative state, and death were found in 85.8%, 2%, 5.1%, 1.5%, and 2.5% of the patients, respectively, according to Glasgow Outcome Scale. Conclusion:Most of the patients were transferred to the hospital by ambulance. Pre-hospital fixation was required in more than half of the patients. Most of the patients showed GCS≥13 and a good recovery outcome, according to GCS.

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“…However, about 12% of the patients with cervical spine injuries are not immobilised. 22 Especially during airway management, manual inline stabilisation may be neglected due to a significant decrease in glottis view and an increased difficulty in intubation. 23 24 There are doubts if external immobilisation is applied in general.…”

Section: Introductionmentioning

confidence: 99%

Cadaveric study of movement in the unstable upper cervical spine during emergency management: tracheal intubation and cervical spine immobilisation—a study protocol for a prospective randomised crossover trial

et al. 2017

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IntroductionEmergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Our study will use myelography method and a wireless human motion tracker to characterise and compare the change of dural sac's space during tracheal intubations and cervical spine immobilisation in the presence of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture.Methods and analysisPerform laryngoscopy and intubation, video laryngoscope intubation, laryngeal tube insertion, fiberoptic intubation and cervical collar application on cadaveric models of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture. The change of dural sac's space and the motion of unstable cervical segment are recorded by video fluoroscopy with previously performing myelography, which enables us to directly measure dural sac's space. Simultaneously, the whole cervical spine motion is recorded at a wireless human motion tracker. The maximum dural sac compression and the maximum angulation and distraction of the injured segment are measured by reviewing fluoroscopic and myelography images.Ethics and disseminationThis study protocol has been approved by the Ethics Committee of the State Medical Association Rhineland-Palatinate, Mainz, Germany. The results will be published in relevant emergency journals and presented at relevant conferences.Trial registration numberDRKS00010499.

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Analysis of prehospital care and emergency room treatment of patients with acute traumatic spinal cord injury: a retrospective cohort study on the implementation of current guidelines

Abstract: The current study shows that recommendations of the current literature and guidelines are mostly followed.

Cited by 16 publications

References 31 publications

Update on critical care for acute spinal cord injury in the setting of polytrauma

Update on critical care for acute spinal cord injury in the setting of polytrauma

Evaluation of Pre-hospital Emergency Services, Non-Surgical Interventions, and Clinical Outcomes in Patients With Traumatic Spine

Cadaveric study of movement in the unstable upper cervical spine during emergency management: tracheal intubation and cervical spine immobilisation—a study protocol for a prospective randomised crossover trial

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