Spinal Injuries in the First Year of a Major Trauma Centre in the UK

1. Spinal Injuries in the First Year of a Major Trauma Centre in the UK A M Hussien,  L Yuinchung, , N Patrick, M Wilson, M Akmal Abstract: Results; Summary of solutions devised: Aim:  St Mary’s Hospital (part of Imperial College NHS Trust in London, became an adult Major Trauma Centre (MTC) in January 2011. Prior to that, there was no neurosurgical service on site and only a tertiary referral service for orthopaedic spinal surgery was available. We reviewed the demographics, mechanisms, injury site, and associated injuries of all spinal trauma patients admitted via the MTC and also report on the challenges encountered in providing a specialist spinal trauma service in a newly designated MTC. Methods: A retrospective review of all admissions to the MTC was performed and patients with spinal injuries were selected for detailed analysis. Difficulties encountered in delivering optimal care i.e. staffing availability, nurse training, physiotherapy expertise, theatre availability, implants and logistical problems were categorised. Summary of the solutions devised is also reported. The service demanded a higher spinal surgical input than was expected and new arrangements were established between orthopaedic and neurosurgical services. Communication difficulties were resolved with twice weekly MDT’s meetings and the use of a computerised and networked patient trauma software (etrauma). A designated weekly spinal trauma list with the availability of extra theatre slots during the week was created. Senior consultants input was required to avoid unnecessary use of MRI imaging, spinal braces, bed days and surgical complications. A core spinal team was created and all patients were handed over during working hours to maintain a continuity of care. Spinal rehabilitation created challenges related to clinical management, bed numbers and onward referral to spinal injury centres St Mary’s Hospital Results: In 2011, the service received 1807 Trauma Calls of which 201 spinal patients (66 were female, 135 male), age (4-95) average 53; mean 38 due to RTA, 87 due to falls (some under the influence of alcohol), and 76 had other injuries and pathology. 71 had cervical spine pathology (9 combined cervical and thoracic injuries), 36 had thoracic pathology (2 combined thoracic and lumbar injuries), 89 had lumbar pathology, 1 sacral and 3 normal. 11 had more than one location of fractures. 76 had various surgical and radiological interventions. Other injuries include 702 with head injury. A total of 79 pediatric cases were admitted to hospital. 32 children with head injuries and 3 with spinal injuries. Conclusion: The creation of new MTC’s in the UK will lead to concentration of spinal trauma surgery to a few specialised centres. The complexity of surgery requires a combination of neurosurgical and orthopaedic skills. Senior consultant input is required at the early phase and clear protocols, communication through MDT’s and junior team infrastructure are essential to avoid unnecessary costs and delays to treatment. Lack of training amongst nurses and physiotherapists needs to be addressed by extra staff with a specialist interest. A regular designated spinal trauma list ensures appropriate theatre staff and equipment availability for surgery. A patient tracking system is essential to keep a record of all inpatients and referrals from a variety of sources. Table one demographics Table three pathology site Table two demographics