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The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004-2008

Citation

Middleton, PM and Davies, SR and Anand, S and Reinten-Reynolds, T and Marial, O and Middleton, JW, The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004-2008, Injury, 43, (4) pp. 480-485. ISSN 0020-1383 (2012) [Refereed Article]

Copyright Statement

Copyright 2012 Elsevier Ltd. All rights reserved.

DOI: doi:10.1016/j.injury.2011.12.010

Abstract

Context: Patients who have sustained a traumatic spinal cord injury require appropriate management in the immediate post-injury period for both survival and to reduce the chances of costly and disabling permanent neurological deficits. Emerging time-critical neuroprotective therapies require the prompt recognition and transfer of patients to a specialised centre for early intervention.

Methods: The Ambulance Research Institute, with the New South Wales State Spinal Cord Injury Service retrospectively linked prehospital data to spinal cord injury unit (SCIU) outcome data for all 324 patients transported by ambulance and subsequently admitted to a SCIU with a persisting traumatic spinal cord injury (SCI) between January 2004 and June 2008, with the aim of identifying factors that impact on the provision of timely and appropriate care.

Results: Paramedics appropriately managed 88% of SCI patients. Only 4.9% of patients had initial vital signs potentially indicative of neurological injury. The median time to a SCIU was 12h, with 60% of patients undergoing multiple transfers. The odds of reaching a SCIU in over 24h were 1.71 times greater for patients injured in a major city (95% CI 1.00-2.90) in comparison to other areas of NSW. More SCI patients with multiple trauma experienced delays in reaching a SCIU (59%), compared to patients with isolated SCI (40%; p=0.039). Patients initially transported to a designated major trauma centre were more likely to be delayed in reaching a SCIU, regardless of whether their injury was an isolated SCI or associated with multiple trauma, compared with other patients. Patients who took greater than 24h to reach a SCIU were 2.5 times more likely to develop a secondary complication (95% CI 1.51-4.17, p=0.0004). Patients who sustained their SCI as a result of a low fall were older and less likely to have their SCI identified and treated early, with less than half of this group reaching a SCIU within 24h compared with other SCI patients (OR 0.42, 95% CI 0.19-0.93, p=0.004).

Conclusion: Early recognition, appropriate prehospital management, triage, timely and appropriate interfacility transfers of all SCI patients are critical for access to specialised care and reducing preventable complications. Elderly fallers present particular challenges to early identification.

Item Details

Item Type:Refereed Article
Keywords:spinal cord injury, prehospital, paramedicine
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Emergency Medicine
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Davies, SR (Ms Suzanne Avis)
ID Code:134402
Year Published:2012
Web of Science® Times Cited:22
Deposited By:Paramedicine
Deposited On:2019-08-12
Last Modified:2019-09-12
Downloads:0

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