Journal of Emergencies, Trauma, and Shock
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Year : 2012  |  Volume : 5  |  Issue : 4  |  Page : 277-278
What's new in emergencies trauma and shock? Studying outcome in traumatic spinal fractures


Department of Trauma, Hannover Medical School, Hannover, Germany

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Date of Submission12-Apr-2012
Date of Acceptance15-Apr-2012
Date of Web Publication15-Oct-2012
 

How to cite this article:
Zeckey C, Mommsen P, Krettek C, Hildebrand F. What's new in emergencies trauma and shock? Studying outcome in traumatic spinal fractures. J Emerg Trauma Shock 2012;5:277-8

How to cite this URL:
Zeckey C, Mommsen P, Krettek C, Hildebrand F. What's new in emergencies trauma and shock? Studying outcome in traumatic spinal fractures. J Emerg Trauma Shock [serial online] 2012 [cited 2014 Sep 15];5:277-8. Available from: http://www.onlinejets.org/text.asp?2012/5/4/277/102352


The study "Presentation and Outcome of Traumatic Spinal fractures" provides interesting and new data of patients who sustained spinal fractures at HGH in Qatar. Due to the fact that HGH is the only tertiary hospital in Qatar, the study presents a nice overview about the overall incidence and causes of traumatic spinal fractures in Qatar.

As also shown in other countries, traumatic spinal injuries frequently occur in young males especially in combination with other injuries leading to multiple trauma. As an Injury Severity Score (ISS) ≥ 16 is internationally accepted for multiple trauma patients, the present study shows reliable data of severely injured patients. Relevant mechanisms of injury include falls, motor vehicle crashs (MVC) and work-related injuries. When compared to the German Trauma Registry, falls and MVC including paedestrians account for over 50% of the included patients; moreover, falls account for over 30%. [1]

As one of the critical factors, principles of preclinical trauma care have to be elucidated carefully. Optimized triage protocols and prehospital advanced trauma life support have been shown to improve outcome in critically injured patients. However, depending on the local trauma system, preclinical setting may involve a physician or paramedic-based preclinical rescue system. [2] In Germany, a physician-based system has been established, which provides high standards of medical care. However, the paramedic-based system is widely accepted internationally. Using protocols and algorithms including invasive procedures such as endotracheal intubation and chest tubes, paramedics in these systems provide high class emergency service. After preclinical triage and therapeutic interventions, decision making regarding the appropriate hospital has to be performed. In this context, the preclinical trauma team should contact the receiving hospital to arrange the admission. Also, some medical advices might be given by the receiving trauma team.

In order to save time, the mode of transport has been discussed in literature. Ground based transport sometimes requires a lot of time from the accident scene to the hospital. In addition, there might be an even increased distance to the most appropriate hospital, e.g., in case of spinal fractures. Therefore, there is an ongoing discussion about the need for helicopter rescue in acute and secondary trauma care. Meanwhile, some studies were not able to demonstrate a beneficial effect of helicopter use; [3] there are reports which highly emphasize the use of helicopters in acute trauma care. Especially in rural areas, the efficiency of helicopters has been demonstrated to improve transport times and outcome. In particular, this comes true for severely injured patients, which we also demonstrated in a study from our department. [4] Also, secondary helicopter transfer after primary care in rural hospitals is an option. However, in spine injured patients with affection of the myelon and concomitant paraplegia, time to intervention is sensible. In these patients, fast but gentle transfer of the patient to a trauma center with spine surgeons should be favored in order to improve outcome. [5]

The authors of the current article did not provide data about preclinical decision making and mode of transport in their study. This lack of data was due to the study design and setting at HGH in Qatar and might be an interesting topic for upcoming reports, studies, or reviews. In general, comparison of the trauma system in Qatar with the respective system in other countries is an interesting topic and should be favored in upcoming reports. Describing the trauma system, this should also include the preclinical trauma setting and its participants.

The authors of the current article interpreted that 82% of all injuries could have been preventable, which once more emphasizes the need for prevention and preventive strategies. This includes graduated licensing and driver education, moreover, local traffic regulations and improved road structures should be favored. The authors underlined this assumption using data from Qatar: prior to camera installation the mean MVC related death rate per 100000 was 19.9 ± 4.1 and after that it was significantly reduced to 14.7 ± 1.5. However, traffic regulation or speed limits are not the only relevant issues in order to reduce MVC-related morbidity or even mortality: seatbelts can reduce the risk for a spinal cord injury by 60%. This comes especially true when combined with airbags resulting in an 80% reduced odds. Thus, preventive measures in this field need to be taken seriously. Besides road traffic accidents, working place safety is an important area for preventive measures. Preventive strategies in regular but especially high risk working places are relevant issues in order to improve safety for employees. Beside protection gear, standardized procedures may help employees in the international context as shown in the Qatarian population. In the presented study, Qatari patients represent 59% in the group between 10 and 20 years of age. Although Qataris did not represent the majority of the overall study population in the present investigation, this data requires further analysis in upcoming analyses. As known from other reports, trauma is the main cause of death among people under 45 years of age in developed countries. In addition, trauma is responsible for most lost of working-years. Particularly with regard to multiple trauma patients, sufficient first aid followed by damage control or early total care is crucial in acute trauma care. Nevertheless, sound principles of corresponding rehab concepts are required once the patient has recovered and the injuries are treated. The rehab strategy is an important factor to brace patients for their biggest challenge: the social reintegration. This is of particular importance in permanently disabled patients, which can be noted in a number of spine injured trauma victims.

Taken together, the authors were able to present new and interesting data of trauma victims suffering from spinal injuries in Qatar. The published report comes along with a comparison to other countries such as USA, China, or Canada, which reflects the data in the international setting.

 
   References Top

1.Trauma Registry of the German Society for Trauma Surgery. Annual report 2011  Back to cited text no. 1
    
2.Zeckey C, Hildebrand F, Probst C, Krettek C. Trauma care systems in Germany, USA and Australia: An international comparison. Unfallchirurg 2010;113:771-4, 776-7.  Back to cited text no. 2
[PUBMED]    
3.Brathwaite CE, Rosko M, McDowell R, Gallagher J, Proenca J, Spott MA. A critical analysis of on-scene helicopter transport on survival in a statewide trauma system. J Trauma 1998;45:140-4; discussion 144-6.  Back to cited text no. 3
[PUBMED]    
4.Frink M, Probst C, Hildebrand F, Richter M, Hausmanninger C, Wiese B, et al. The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry. Unfallchirurg 2007;110:334-40.  Back to cited text no. 4
[PUBMED]    
5.Mirza SK, Krengel WF 3 rd , Chapman JR, Anderson PA, Bailey JC, Grady MS, et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 1999:104-14.  Back to cited text no. 5
    

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Correspondence Address:
Christian Zeckey
Department of Trauma, Hannover Medical School, Hannover
Germany
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DOI: 10.4103/0974-2700.102352

PMID: 23248493

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