Emergency and acute care management of traumatic spinal cord injury: a survey of current practice among senior clinicians across Australia

BMC Emergency Medicine, 2018 · DOI: https://doi.org/10.1186/s12873-018-0207-0 · Published: November 23, 2018

Simple Explanation

This study investigates how senior clinicians in Australia manage acute traumatic spinal cord injuries (TSCI) in pre-hospital, emergency, and acute care settings. It highlights the variations in clinical practices and the use of evidence-based guidelines. The survey reveals a lack of consistent adherence to established guidelines, with many clinicians relying on local protocols or no specific guidelines. This inconsistency leads to conflicting approaches in patient assessment, treatment, and transport decisions. The research emphasizes the need for standardized care across all phases of TSCI management to improve patient outcomes. It suggests that consistent, evidence-based practices from first responders through acute care are crucial for these devastating injuries.

Study Duration

Not specified

Participants

95 senior clinicians

Evidence Level

Level IV, Cross-sectional Survey

Key Findings

1
Many clinicians do not consistently use evidence-based guidelines for acute TSCI care, often following locally written or no specific guidelines.
2
Spinal immobilization practices and blood pressure target settings vary significantly among clinicians.
3
Access to specialist care consults and SCIU beds is reported as problematic by a substantial portion of clinicians.

Research Summary

This survey of senior clinicians across Australia reveals significant variability in the acute care management of traumatic spinal cord injury (TSCI). The study highlights inconsistencies in the use of evidence-based guidelines, spinal immobilization practices, and blood pressure management, indicating a need for standardized care. Findings suggest that improving adherence to best practice standards and ensuring timely access to specialist centers could lead to better outcomes for patients with TSCI.

Practical Implications

Standardized Care Pathways

Development and implementation of nationally standardized clinical practice guidelines for TSCI management to reduce variability and improve patient outcomes.

Improved Access to Specialist Care

Ensuring timely access to specialist spinal cord injury units (SCIU) through non-refusal policies and efficient transfer protocols.

Enhanced Training and Education

Providing comprehensive training and education for clinicians on evidence-based practices for TSCI assessment, management, and transport.

Study Limitations

1
Not all clinicians were competent to respond to every question.
2
The survey respondents represented five states in Australia yet findings were not adjusted by state based differences.
3
The impact of clinical practice variability on patient outcomes is unknown.

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