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Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey.
MedLine Citation:
PMID:  21939394     Owner:  NLM     Status:  Publisher    
The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanaesthetists in all neurosurgical centres that manage patients with acute spinal cord injury. Two clinical scenarios - of complete and incomplete cervical spinal cord injuries - were given to determine local treatment policies. There were 175 responders from the 33 centres (36 % response rate). We ascertained neurosurgical views on urgency of transfer, timing of surgery, nature and aim of surgery; and neuroanaesthetic views on type of anaesthetic, essential intraoperative monitoring, drug treatment and intensive care management. Approximately 70% of neurosurgeons will admit patients with incomplete spinal cord injury immediately, but only 40 % will admit patients with complete spinal cord injury immediately. There is no consensus on the timing or even the role of surgery for incomplete or complete injuries. Most (96%) neuroanaesthetists avoid anaesthetics known to elevate intracranial pressure. What was deemed essential intraoperative monitoring, however, varied widely. Many (22%) neuroanaesthetists do not routinely measure arterial blood pressure invasively, central venous pressure (85%) or cardiac output (94%) during surgery. There is no consensus amongst neuroanaesthetists on the optimal levels of arterial blood pressure, oxygen and carbon dioxide arterial partial pressure. We report wide variability amongst UK neurosurgeons and neuroanaesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.
Melissa C Werndle; Argyro Zoumprouli; Philip Sedgwick; Marios C Papadopoulos
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-22
Journal Detail:
Title:  Journal of neurotrauma     Volume:  -     ISSN:  1557-9042     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
St George's University of London, Academic Neurosurgery Unit, Room 1.122, Cranmer Terrace, London, United Kingdom, SW17 0RE;
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