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
Author(s): Hill, Daniel S.; Marynissen, Hans
Source: Spine (03622436); Oct 2018; vol. 43 (no. 20)
Publication Date: Oct 2018
Publication Type(s): Academic Journal
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.
Author(s): Staal J.; Kariki E.; Hyatt R.; Javaid M.K.; Russell E.; aO'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; 2018; vol. 29 (no. 1)
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objective: Vertebral fragility fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of VFFs in computed tomography (CT) scans of the thorax, abdomen and pelvis and reviewed whether they had been previously reported. We also investigated whether the identified VFF patients had been referred to an FLS. Methods: We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine, and performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial casefinding service combining machine learning with radiologist overread (EK). VFFs were classified using the Genant-SQ method and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Results:We collected 47,889 scans (50.1%) and used a sample of 1638 scans for analysis. Of these, 237 patients (53.4% ) had VFFs (14.5%+/-1.7%, 95%CI). VFF prevalence between sites was not significantly different. Four sites (Ca., Cr., E.L., Ox.) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusions: On average, 1 in 7 patients had at least one moderate VFF with a median of 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs2, nearly as many men as women were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis.
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