Is the Current Management of Patients Presenting With Spinal Trauma to District General Hospitals Fit for Purpose?: Our Experience of Delivering a Spinal Service Using an Electronic Referral Platform in a Large District General Teaching Hospital Without Onsite Spinal Services

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Abstract

Study Design.

A retrospective cross-sectional analysis.

Objective.

The aim of this study was to describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and to quantify the time taken to obtain definitive management plans while under prescribed spinal immobilization.

Summary of Background Data.

Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist center.

Methods.

A retrospective review of 104 patients admitted following vertebral trauma during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that “spinal immobilisation is not recommended for more than 48 hours” was the standard of care measured against.

Results.

One hundred patients occupied a total of 975 hospital inpatient bed days. One hundred and seventeen radiological investigations were requested after the point of external referral [47 computed tomography (CT)-scans, 37 magnetic resonance imaging (MRI)-scans, and 33 weight-bearing radiographs]. The period between initial referral to the regional spinal service and then receiving a definitive final management plan had a median value of 72 hours and a range of 0 and 33 days. Patients will have been under some form of prescribed spinal immobilization until the definitive management plan was communicated. Thirty-four patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. Eighty patients had vertebral injuries (73 stable, six unstable), three patients had prolapsed intervertebral disks, one had metastatic disease, and 17 did not have evidence of an acute injury following evaluation.

Conclusion.

Patients are being placed under prescribed immobilization for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan.

Conclusion.

Level of Evidence: 4

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