Ambulance Research Institute, Rozelle, NSW 2039, Australia.
Injury. 2012 Apr;43(4):480-5. doi: 10.1016/j.injury.2011.12.010. Epub 2012 Jan 11.
Patients who have sustained a traumatic spinal cord injury require appropriate management in the immediate post-injury period for both survival and to reduce the chances of costly and disabling permanent neurological deficits. Emerging time-critical neuroprotective therapies require the prompt recognition and transfer of patients to a specialised centre for early intervention.
The Ambulance Research Institute, with the New South Wales State Spinal Cord Injury Service retrospectively linked prehospital data to spinal cord injury unit (SCIU) outcome data for all 324 patients transported by ambulance and subsequently admitted to a SCIU with a persisting traumatic spinal cord injury (SCI) between January 2004 and June 2008, with the aim of identifying factors that impact on the provision of timely and appropriate care.
Paramedics appropriately managed 88% of SCI patients. Only 4.9% of patients had initial vital signs potentially indicative of neurological injury. The median time to a SCIU was 12h, with 60% of patients undergoing multiple transfers. The odds of reaching a SCIU in over 24h were 1.71 times greater for patients injured in a major city (95% CI 1.00-2.90) in comparison to other areas of NSW. More SCI patients with multiple trauma experienced delays in reaching a SCIU (59%), compared to patients with isolated SCI (40%; p=0.039). Patients initially transported to a designated major trauma centre were more likely to be delayed in reaching a SCIU, regardless of whether their injury was an isolated SCI or associated with multiple trauma, compared with other patients. Patients who took greater than 24h to reach a SCIU were 2.5 times more likely to develop a secondary complication (95% CI 1.51-4.17, p=0.0004). Patients who sustained their SCI as a result of a low fall were older and less likely to have their SCI identified and treated early, with less than half of this group reaching a SCIU within 24h compared with other SCI patients (OR 0.42, 95% CI 0.19-0.93, p=0.004).
Early recognition, appropriate prehospital management, triage, timely and appropriate interfacility transfers of all SCI patients are critical for access to specialised care and reducing preventable complications. Elderly fallers present particular challenges to early identification.
外伤性脊髓损伤患者需要在损伤后立即进行适当的治疗，以确保生存并降低出现昂贵且致残性永久性神经功能缺损的几率。新兴的时间关键型神经保护疗法需要及时识别患者，并将其转送至专门中心以进行早期干预。
新南威尔士州脊髓损伤服务中心的急救研究所，对 2004 年 1 月至 2008 年 6 月间，通过救护车转运至脊髓损伤单元（SCIU）并被诊断为持续性外伤性脊髓损伤（SCI）的 324 例患者的院前数据与 SCIU 结局数据进行了回顾性链接，目的是确定影响及时和适当治疗的因素。
88%的脊髓损伤患者接受了恰当的院前处理。仅有 4.9%的患者存在可能提示神经损伤的初始生命体征。进入 SCIU 的中位数时间为 12 小时，60%的患者经历了多次转运。与新南威尔士州其他地区相比，在大城市受伤的患者到达 SCIU 的时间超过 24 小时的可能性高 1.71 倍（95%CI 1.00-2.90）。与单纯性 SCI 患者相比，伴有多发创伤的 SCI 患者到达 SCIU 的时间延迟（59%）更常见（p=0.039）。与其他患者相比，最初被转运至指定的大型创伤中心的患者无论其损伤是单纯性 SCI 还是与多发创伤相关，均更有可能延迟到达 SCIU。到达 SCIU 的时间超过 24 小时的患者发生二次并发症的可能性增加 2.5 倍（95%CI 1.51-4.17，p=0.0004）。由于低坠受伤而导致 SCI 的患者年龄较大，且不太可能早期识别和治疗 SCI，与其他 SCI 患者相比，这组患者中有不到一半的人在 24 小时内到达 SCIU（OR 0.42，95%CI 0.19-0.93，p=0.004）。
早期识别、适当的院前管理、分诊、所有 SCI 患者的及时和适当的机构间转运，对于获得专科治疗和减少可预防的并发症至关重要。高龄坠伤者尤其难以早期识别。
