Preclinical Treatment of Spinal Injuries from a Trauma Surgery Perspective - The Austrian Model

Abstract

Background: Due to the lack of relevant data regarding the efficiency and effect of preclinical treatment of spinal injuries, there is a distinct lack of specific guidelines within this field. Although rescue methods are to some extent regulated by guidelines, there is a lack of specific guidelines regarding subsequent medication therapies and other further measures. This representative study is intended to generate recommendations with regard to the treatment of patients with spinal injuries, based on the practised procedures in Austria.
Methods: The current status of the treatment provided to spinal injury patients with regard to rescue methods, auxiliary devices, documentation, extent of volume substitution and medication used was documented by means of a representative survey of all trauma surgery hospitals or clinics that treat spinal injuries in Austria (representative participation of 97.0 %).
Results: Auxiliary devices such as vacuum mattresses and external spine stabilising devices are used in 93.6 %, i. e. 92.1 % of all cases. Intravenous access is applied in 95.2 % of cases; oxygen is administered in 68.3 %. Opiates (74.6 %) and ketamine (23.8 %) are most frequently used for sedation and as analgesics. Neuroprotective therapy, by means of administrating cortisone, is initiated preclinically in 74.6 % of cases.
Conclusion: Careful rescue, the use of splinting devices, and fast transportation in conjunction with continuous volume substitution are vital prerequisites for successful treatment. A rough neural examination is sufficient for assessing neurological function during the preclinical phase. Cortisone therapy may be initiated preclinically, if neurological deficits are suspected.

Key words

Guidelines for preclinical treatment - spinal injuries - emergency medical aid - neuroprotective therapy

References

• 1 Barquist E, Pizzutiello M, Tian L, Cox C, Bessey P Q. Effect of trauma system maturation on mortality rates in patients with blunt injuries in the Finger Lakes Region of New York State.  J Trauma. 2000;  49 63-69
• 2 Berry F A. Perioperative anesthetic management of the pediatric trauma patient.  Crit Care Clin. 1990;  6 147-163
• 3 Bracken M B, Shepard M J, Holford T R, Leo-Summers L, Aldrich E F, Fazl M, Fehlings M G, Herr D L, Hitchon P W, Marshall L F, Nockels R P, Pascale V, Perot P L, Piepmeier J, Sonntag V K, Wagner F, Wilberger J E, Winn H R, Young W. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow-up. Results of the third National Acute Spinal Cord Injury randomized controlled trial.  J Neurosurg. 1998;  89 699-706
• 4 Garfin S R, Shackford S R, Marshall L F, Drummond J C. Care of the multiply injured patient with cervical spine injury.  Clin Orthop. 1989;  239 19-29
• 5 Gerling M C, Davis D P, Hamilton R S, Morris G F, Vilke G M, Garfin S R, Hayden S R. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation.  Ann Emerg Med. 2000;  36 293-300
• 6 Gerndt S J, Rodriguez J L, Pawlik J W, Taheri P A, Wahl W L, Micheals A J, Papadopoulos S M. Consequences of high-dose steroid therapy for acute spinal cord injury.  J Trauma. 1997;  42 279-284
• 7 Grossman M D, Reilly P M, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers.  J Trauma. 1999;  47 684-690
• 8 Hanigan W C, Anderson R J. Commentary on NASCIS-2.  J Spinal Disord. 1992;  5 125-131
• 9 Jaffe D M, Binns H, Radkowski M A, Barthel M J, Engelhard H H. Developing a clinical algorithm for early management of cervical spine injury in child trauma victims.  Ann Emerg Med. 1987;  16 270-276
• 10 Jeanneret B, Magerl F, Ward J C. Overdistraction: a hazard of skull traction in the management of acute injuries of the cervical spine.  Arch Orthop Trauma Surg. 1991;  110 242-245
• 11 Lieberman I H, Webb J K. Cervical spine injuries in the elderly.  J Bone Joint Surg Br. 1994;  76 877-881
• 12 Lord S A, Boswell W C, Williams J S, Odom J W, Boyd C R. Airway control in trauma patients with cervical spine fractures.  Prehospital Disaster Med. 1994;  9 44-49
• 13 Meldon S W, Brant T A, Cydulka R K, Collins T E, Shade B R. Out-of-hospital cervical spine clearance: agreement between emergency medical technicians and emergency physicians.  J Trauma. 1998;  45 1058-1061
• 14 Nechwatal E. Critical notes on the transport of patients with cervical spinal cord injuries.  Chirurg. 1975;  46 521-523
• 15 Nesathurai S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials.  J Trauma. 1998;  45 1088-1093
• 16 Nesathurai S. The role of methylprednisolone in acute spinal cord injuries.  J Trauma. 2001;  51 421-423
• 17 Obrist W D, Langfitt T W, Jaggi J L, Cruz J, Gennarelli T A. Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension.  J Neurosurg. 1984;  61 241-253
• 18 Piek J, Chesnut R M, Marshall L F, Berkum-Clark M, Klauber M R, Blunt B A, Eisenberg H M, Jane J A, Marmarou A, Foulkes M A. Extracranial complications of severe head injury.  J Neurosurg. 1992;  77 901-907
• 19 Soderstrom C A, Brumback R J. Early care of the patient with cervical spine injury.  Orthop Clin North Am. 1986;  17 3-13
• 20 Young W. NASCIS. National Acute Spinal Cord Injury Study.  J Neurotrauma. 1990;  7 113-114
• 21 Young W, Bracken M B. The Second National Acute Spinal Cord Injury Study.  J Neurotrauma. 1992;  9 (Suppl 1) S397-S405