Improving spinal trauma management in non-specialist centres

Fractures of the vertebral column are increasing in incidence. Even though spinal trauma is increasingly being managed in specialist units, these patients often still initially present to district general hospitals. Due to lack of exposure to these patients, the attending Orthopaedic Senior House Officer may not always be aware of current best practice in the acute management of these patients beyond immediate Advance Trauma Life Support measures. There is concern that initiation of management may be delayed as a result of lack of a concise documented plan. The physiotherapy team requires specific instructions from the orthopaedic team before they can attempt to mobilise these patients. Lack thereof may lead to inappropriate prolonged immoblisation, prolonged hospital admission and, as a result, medical complications such as aspiration pneumonia, other nosocomial infections or pressure sores. An audit of departmental practice in two district general hospitals in the London and KSS deaneries demonstrated that a lack of easily accessible guidelines led to delays in definitive management of these patients with several episodes of medical concern. A proforma was devised in conjunction with the physiotherapy department and the regional spinal orthopaedic service in order to aid doctors in formulation of these management plans. These were rolled out effectively in both centres and re-audit in the first centre demonstrated marked improvement in patient care. Re-audit in the second hospital is ongoing.