Comparison of Outcomes for Children With Cervical Spine Injury Based on Destination Hospital From Scene of Injury

Anders, Jennifer; Adelgais, Kathleen; Hoyle, John D.; Olsen, Cody S.; Jaffe, David M.; Leonard, Julie C.

doi:10.1111/acem.12288

Cited by 19 publications

(13 citation statements)

References 38 publications

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“…Currently, evidence supporting benefits of direct admission is limited, 44 as most SCI studies examined the benefits of early admission instead (i.e., within 24 h post-injury), and none stratified the injury by distance to SCI center. 2 , 4 , 5 , 10 However, direct admission for injuries within 40 km of a SCI center, and hence early access to care, offers many opportunities that would position patients and the healthcare system to gain substantially in the long term.…”

Section: Discussionmentioning

confidence: 99%

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Cheng

Noonan

Shurgold

et al. 2017

Journal of Neurotrauma

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Current research indicates that more than half of patients with traumatic spinal cord injury (tSCI) experience delays in transfer and receive surgery >24 h post-injury. The objectives of this study were to determine the geographic distribution of tSCI in Canada relative to specialized treatment facilities, to assess clinical and logistical factors at play for indirect admissions to those facilities, and to explore differences in current time to admission and simulated scenarios in an attempt to assess the potential impact of changes to triage protocols. This study included data from 876 patients with tSCI enrolled in the prospectively collected acute Rick Hansen Spinal Cord Injury Registry (RHSCIR) between January 1, 2010 and December 31, 2013 for whom there were data on the location of their injury. Patients transported directly to a RHSCIR acute facility were more likely to reach the facility within 1 h of injury, whereas those transported indirectly were more likely to arrive 7 h later. Considering the injuries occurring within 40 km of a RHSCIR acute facility (n = 323), 249 patients (77%) were directly and 74 (23%) were indirectly admitted. In the multivariate regression analysis, only older age and longer road distance remained significantly associated with being indirectly admitted to a RHSCIR facility. Compared with the current status, the median time to admission decreased by 20% (3.5 h) in the 100% direct admission scenario, and increased by 102% (8.9 h) in the 100% indirect admission scenario.

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Section: Discussionmentioning

confidence: 99%

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Cheng

Noonan

Shurgold

et al. 2017

Journal of Neurotrauma

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“…When establishing an ‘appropriate’ destination facility, paramedics must determine the likelihood of the patient requiring specialist services (personnel and equipment) and whether these will be available by the time the ambulance arrives. If the need for more specialised care or services is probable, smaller facilities may be bypassed . Almost 50% of patients initially transported to a more distant facility were within 15 km of the nearest hospital (43%), but it was twice as likely to occur outside of normal business hours (Monday to Friday, 8 a.m. to 6 p.m.).…”

Section: Discussionmentioning

confidence: 99%

“…If the need for more specialised care or services is probable, smaller facilities may be bypassed. 5,25 Almost 50% of patients initially transported to a more distant facility were within 15 km of the nearest hospital (43%), but it was twice as likely to occur outside of normal business hours (Monday to Friday, 8 a.m. to 6 p.m.). Urgent care facilities are usually staffed outside business hours by local general practitioners with differing levels of experience with paediatric patients and a reduced nursing staff.…”

Section: Ambulance Victoriamentioning

confidence: 99%

Initial destination hospital of paediatric prehospital patients in rural Victoria

Kloot

Salzman

Kilpatrick

et al. 2016

Emerg Medicine Australasia

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“…1) bis hin zur kompletten Querschnittsymptomatik [2,4,11]. Das Outcome dieser schwer verletzten Kinder kann verbessert werden, wenn bereits initial der Transport in ein entsprechendes Schwerpunktzentrum erfolgt [12].…”

Section: Merkeunclassified

Wirbelsäulenverletzungen im Kindesalter – Konzepte zu Diagnostik und Therapie

Kreinest¹,

Vetter²,

Grützner³

et al. 2018

OP-JOURNAL

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ZusammenfassungNur 5 – 10% aller Wirbelsäulenverletzungen betreffen Kinder. Über 90% dieser Kinder mit einer Verletzung der Wirbelsäule haben ihr 16. Lebensjahr bereits erreicht. Bei Kindern unter dem 10. Lebensjahr ist am häufigsten die Halswirbelsäule betroffen. Zwischen 12 und 27% der Kinder mit einer Verletzung der Wirbelsäule haben begleitende neurologische Defizite bis hin zur kompletten Querschnittsymptomatik. Sowohl für die Diagnostik als auch für die Therapie von Verletzungen der Wirbelsäule im Kindesalter sind Kenntnisse über die Ossifikation der Wirbelkörper sowie über weitere anatomische und biomechanische Besonderheiten der heranwachsenden Wirbelsäule erforderlich. Neben der klinischen und neurologischen Untersuchung erfolgt die Diagnostik hauptsächlich mittels Röntgen und kernspintomografischer Bildgebung. Für die Frakturen der Wirbelsäule im Kindesalter existieren spezielle Klassifikationssysteme. Im Vergleich zum Erwachsenen ist bei Kindern mit Verletzungen der Wirbelsäule häufiger eine konservative Therapie möglich. Alle stabilen Frakturen sowie die typischen Verletzungen der Endplatten können prinzipiell funktionell nachbehandelt werden. Auch Verletzungen, die eine geringgradige Veränderung des physiologischen Alignments verursachen, können oftmals noch konservativ therapiert werden. An der Halswirbelsäule wird die Indikation zur Stabilisierung vor allem bei deutlich gestörtem zervikalen Alignment gestellt. Oftmals erfolgt die Therapie im Halofixateur. Alternativ kann die Stabilisierung mittels Fixateur interne oder direkter Verschraubung erfolgen. Bei Verletzungen der Brust- und Lendenwirbelsäule wird eine operative Therapie empfohlen, wenn sich eine posttraumatische Segmentkyphose von über 20° ausbildet. Nach Reposition erfolgt hier meist die dorsale Instrumentierung. Generell zeigen Kinder mit Verletzungen der Wirbelsäule ein gutes Outcome.

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Comparison of Outcomes for Children With Cervical Spine Injury Based on Destination Hospital From Scene of Injury

Cited by 19 publications

References 38 publications

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Initial destination hospital of paediatric prehospital patients in rural Victoria

Wirbelsäulenverletzungen im Kindesalter – Konzepte zu Diagnostik und Therapie

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