Spinal clearance practices at a regional Australian hospital: a window to major trauma management performance outside metropolitan trauma centres

Carter, Angus W., Jacups, Susan P., Ackland, Helen M., Wright, Andrew, Lawson, Amy, Armit, Drew, and Mooney, Richard (2017) Spinal clearance practices at a regional Australian hospital: a window to major trauma management performance outside metropolitan trauma centres. Journal of Emergency Medicine Trauma & Acute Care, 2017 (5). pp. 1-9.

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Background: Prevention of secondary spinal injury via spinal protection measures is a standard component of trauma management, and a high-quality spinal clearance process is imperative in achieving this aim. To evaluate the current practice with a view to achieving best practice, we sought to examine the spinal clearance process and outcomes at a regional Australian referral hospital, which services a large geographical catchment area.

Methods: A retrospective review of medical records of all patients with major trauma who presented to an Australian regional hospital during 2014 was conducted. The primary outcome measure was missed or delayed diagnosis of spinal injury. Secondary outcome measures included compliance with internationally accepted spinal clearance process measures, timing and choice of appropriate imaging modalities, rates of spinal injury and documentation of spinal clearance.

Results: Of the 112 patients with major trauma who met the study eligibility criteria and were discharged from hospital during the study period from 1 January to 31 December 2014, 11 spinal injuries were missed or delayed in diagnosis. The injuries occurred in 3.6% of patients and all were thoracolumbar spine (TLS) injuries. The predominant reasons for missed or delayed diagnosis were reduced sensitivity of plain X-ray compared with computed tomography for spinal injury screening and incomplete full spinal imaging to detect non-contiguous fractures.

Conclusion: Evidence-based clinical decision rules are imperative in ascertaining the need for imaging in the TLS and would be enhanced by an internationally recognised definition of clinical significance based on injury morphology rather than clinician management decision alone. In addition, regional hospitals may have limited capacity to achieve spinal clearance, and other trauma quality assurance standards commensurate with national and international benchmarks without the valuable performance feedback provided by state trauma registries, as is currently the case in Queensland.

Item ID: 49115
Item Type: Article (Research - C1)
ISSN: 1999-7094
Keywords: major trauma, spinal clearance, spinal injury, thoracolumbar spine
Additional Information:

© 2017 Carter, Jacups, Ackland, Wright, Lawson, Armit, Mooney, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.

Date Deposited: 27 Jun 2017 23:06
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 80%
42 HEALTH SCIENCES > 4203 Health services and systems > 420399 Health services and systems not elsewhere classified @ 20%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 50%
92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 50%
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