Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

World Journal of Emergency Surgery, 2024 · DOI: https://doi.org/10.1186/s13017-023-00525-4 · Published: January 1, 2024

Simple Explanation

Traumatic spinal cord injury (tSCI) combined with other injuries (polytrauma) presents a significant challenge in emergency medicine. This consensus aims to offer guidance on the initial steps in managing these complex cases within the first 24 hours after the injury. A panel of experts from different medical fields collaborated to create recommendations for managing tSCI patients with polytrauma. They used a structured method to review existing research and develop consensus-based recommendations. The consensus resulted in 17 recommendations, covering various aspects of early management, including immediate life support, neurological evaluation, imaging, and surgical considerations. These recommendations aim to help clinicians make informed decisions.

Study Duration

May to September 2023

Participants

Multidisciplinary consensus panel of physicians (neurosurgeons, anesthesiologists/intensivists/neurointensivists, acute care surgeons, orthopedists, neuroradiologists, emergency physicians and neurologists)

Evidence Level

Level V, Consensus and Clinical Recommendations

Key Findings

1
Immediate life support interventions are crucial for salvageable tSCI polytrauma patients with life-threatening conditions, including intubation, mechanical ventilation, and hemodynamic support.
2
Urgent neurological evaluation and imaging (CT scan) are needed for tSCI polytrauma patients without life-threatening conditions or after cardiorespiratory stabilization.
3
Early decompressive surgery (within 24 hours from trauma) should be considered for all salvageable tSCI polytrauma patients with surgical spinal lesions, after control of life-threatening conditions.

Research Summary

This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients. The consensus was endorsed jointly by the WSES and the European Association of Neurosurgical Societies (EANS). A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak).

Practical Implications

Standardized Early Management

The consensus provides a framework for the early management of tSCI patients with polytrauma, potentially reducing variability in clinical practice and improving patient outcomes.

Multidisciplinary Collaboration

The emphasis on strict collaboration between different medical specialties highlights the importance of a coordinated approach in managing these complex patients.

Informed Decision-Making

The recommendations support clinicians in making informed decisions regarding life support, neurological evaluation, imaging, surgical intervention, and coagulation management in the acute phase of tSCI polytrauma.

Study Limitations

1
Sparse data is available to provide optimal care in this scenario
2
Worldwide variability in clinical practice has been documented in recent studies.
3
The guidelines promulgated in this work do not represent a standard of practice and have no legal implications.

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