Trauma & Orthopaedic Registrar, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
Spinal Senior Clinical Fellow, Salford Royal Hospital, Stott Lane, Salford, M8 8HD, UK.
Int J Orthop Trauma Nurs. 2024 May;53:101083. doi: 10.1016/j.ijotn.2024.101083. Epub 2024 Feb 5.
Upper cervical spine fractures are commonplace in the elderly following low energy trauma. These injuries carry high mortality rates, similar to patients sustaining hip fractures. A key aspect affecting clinical outcome is effective management in the first 12 weeks following injury. This study aims to assess the understanding of healthcare staff that may be required to care for such patients.
A survey was carried out over a single day at the UK's largest Spine Specialist referral centre (Salford Royal Foundation Trust, SRFT) assessing the understanding of healthcare staff of the term, 'Collar with occipital extension', by asking staff to identify the safe position of the neck when looking at clinical images of a model in a collar in various different neck positions. The participants demographics were then taken, including profession, grade, spinal/post graduate experience, if English is their first language and their understanding of the term 'Collar with occipital extension'.
102 participants were interviewed and the results showed almost half (45.1%) of participants selecting an incorrect hyperextended neck to be a safe position for conservative treatment and only 37.3% selecting the neutral position as satisfactory. The only positive predictors identified for those selective the neutral safe cervical spine alignment was if participants had >5 years of previous spinal experience (p = 0.0006) or if they understood the term 'Collar with occipital extension' to be describing the collar component (p = 0.000013) and not neck position.
Management of spinal injuries are classically poorly managed in non-spinal centres, possibly due to the lack of training and understanding within the spinal speciality. This study shows the importance of clearly communicating with referring hospitals exactly how to conservatively manage patients with high cervical injuries to best improve clinical outcome.
老年人在受到低能量创伤后，颈椎上段骨折很常见。这些损伤的死亡率很高，与髋部骨折患者相似。影响临床结果的一个关键因素是在受伤后 12 周内进行有效的治疗。本研究旨在评估医护人员在护理此类患者时可能需要的理解程度。
在英国最大的脊柱专科转诊中心（索尔福德皇家基金会信托医院，SRFT）进行了一项为期一天的调查，通过要求医护人员在查看佩戴颈托的模特处于不同颈部位置的临床图像时，识别出颈部的安全位置，来评估他们对“带枕骨延伸的颈托”这一术语的理解。然后记录参与者的人口统计学信息，包括职业、职称、脊柱/研究生经验、英语是否为母语以及对“带枕骨延伸的颈托”这一术语的理解。
对 102 名参与者进行了访谈，结果显示，近一半（45.1%）的参与者选择了过度伸展的颈部作为保守治疗的安全位置，只有 37.3%的参与者选择了中立位置作为满意位置。对于选择中立安全颈椎排列的参与者，唯一确定的积极预测因素是，如果参与者有超过 5 年的脊柱经验（p=0.0006），或者他们理解“带枕骨延伸的颈托”是描述颈托部件（p=0.000013），而不是颈部位置。
在非脊柱中心，脊柱损伤的管理通常很差，这可能是由于脊柱专科缺乏培训和理解。本研究表明，与转诊医院明确沟通如何对高颈椎损伤患者进行保守治疗，以最佳改善临床结果非常重要。
