Heterogeneous emergency department management of published recommendation defined hypotension in patients with acute traumatic spinal cord injury: A multi‐centre overview

Abstract

Objective: Evidence-based management for patients with acute traumatic spinal cord injury (TSCI) in the ED has a critical impact on longterm outcomes. Acute hypotension post-injury may compromise spinal cord perfusion and extend neurological damage. Published guidelines recommend mean arterial blood pressure (BP) maintenance between 85 and 90 mmHg for 7 days postinjury; the extent to which this is followed in Australia is unknown. Methods: Prospective observational study of patients ≥16 years with TSCI, treated at 48 hospitals across two Australian states. Mean arterial BPs were recorded in the Ambulance, and ED arrival and discharge. Patients' medical records documented treatment provided (intravenous fluids, vasopressors or both) for BP augmentation. Hypotension was defined as mean arterial BP <85 mmHg, per the American Association of Neurological Surgeons guidelines. Results: The 208 patients with TSCI in the present study were more likely to receive BP augmentation if they experienced direct transport to a Spinal Cord Service hospital (OR 5.57, 95% CI 2.32-10.11), had a cervical level injury (OR 2.32, 95% CI 1.01-5.5) or were hypotensive on ED arrival (OR 2.42, 95% CI 1.34-4.39). Of the 112 patients who were hypotensive, 71 (63.4%) received treatment for this; however, the majority (76%) remained hypotensive on discharge. Conclusion: Hypotensive patients' post-TSCI experienced heterogeneous ED care discordant with published guidelines; varying by hospital type. Specialist care and more severe injury increased likelihood of guideline adherence. Lack of adherence may influence patient outcomes. Level 1 evidence is needed along with consistent guideline implementation and clinician training to likely improve TSCI management and outcomes.

Concurrent Spinal Trauma in Patients with Traumatic Head Injury: A Seven-Year Retrospective Analysis

“…All patients with spinal injuries had ≤89/130 mmHg blood pressure at the time of Emergency Department admission. The blood pressure results of the patients in the current study were in line with that of available studies on the Hong Kong population [ 11 ], retrospective studies [ 3 , 23 ], and a prospective observational study [ 26 ]. The traumatic head injury causes degeneration of the white matter of the spinal cord, leading to hypotension in cases of spinal injuries [ 27 ].…”

Application of the Whole Optimization of Emergency Nursing Model United and Its Influence on Patients’ Stress Response and Nursing Satisfaction

“…The patients' CRP levels were compared before and after nursing The first aid time indexes. It included residence time in the emergency room, examination time, and arrival time of nursing staff and doctors in the emergency department [ 15 ] The treatment effect. If the patients' indexes returned to normal, it was recovered.…”

“…The first aid time indexes. It included residence time in the emergency room, examination time, and arrival time of nursing staff and doctors in the emergency department [ 15 ]…”

Treatment Modalities of Trauma Care

“…However, a patient may be experiencing neurogenic shock if their hypotension is resistant to fluid resuscitation and bradycardia is noticed. 11 This syndrome develops when an injury to the upper thoracic and cervical portions of the spinal cord affects the sympathetic fibers that control the heartbeat, causing bradycardia and hypotension that may be resistant to fluid therapy. Vasopressors are often needed during treatment to make up for the decrease of sympathetic tone and vasodilation that occurs.…”