A multi-centred audit of secondary spinal assessments in a trauma setting: are we ATLS compliant?

Abstract

The global incidence of spinal cord injuries varies with the developed world having improved survival and 1year mortality in a poly-trauma setting. This improved survival has been estimated at 20% in a recent Cochrane review of Advanced Trauma Life Support (ATLS).The aim of this audit is to evaluate the management of patients with suspected spinal cord injury by the trauma and orthopaedic team in three centres in South Wales. A retrospective case note review of the secondary survey was performed. Inclusion criteria were patients 18years and above, with poly-trauma and presenting to Accident and Emergency department at the treating hospital. We used ATLS guidelines as an audit tool and reviewed the documentation of key components of the secondary assessment. Forty-nine patients were included (29 males, 20 females) with an average age of 53.7years (19-92years). We found that completion of all components of the secondary survey for spinal injury was poor, 29% receiving a digital per rectal examination despite suspected spinal injury. Paralysis level was not documented in 20.4% of patients. Medical Research Council grade was only documented in 24.5% although was assessed in 73.5%. The secondary survey took place after 2h in 54.6% of patients. We found that the documentation of the performance of a secondary survey was poor. We found that most patients included in this study are not currently meeting the minimal standard suggested by the ATLS guidelines.