New Guidelines Help Trauma Centers Treat Spinal Injury Patients

The American College of Surgeons (ACS) Trauma Quality Programs recently announced new guidelines on spine injuries to provide trauma centers with a practical guide to evaluate and manage adult patients with spinal injury. The recently released ACS Trauma Quality Program’s Spine Injury Best Practices Guidelines was developed from evidence-based literature and expert input from leaders in the fields of neurosurgery and orthopaedic surgery.

Fractures of the spinal column represent a small proportion of all fractures from traumatic injury with an incidence ranging from 4% to 23%, the authors noted in the guidelines’ introduction. However, the impact of these fractures on the individual and the healthcare system is significant because of their potential for long-term disability, the associated health care consequences, and costs.

The Spine Injury Best Practices Guidelines provide a practical guide for the evaluation and management of an adult patient with a spinal injury, including both spinal column fracture and spinal cord injury (SCI). The ACS Best Practices project team collaborated with guest experts to create the guidelines.

“The Spine Injury Best Practices Guidelines is an excellent resource for the diagnosis and management of the trauma patient with spine and spinal cord injuries. The section on implementation suggests how to incorporate the recommendations into each trauma center’s care and the section on integration provides methods for integrating care for spine injury into trauma center performance improvement. Overall, I believe that it will improve care for the spine and spinal cord injured patient,” said Christine Cocanour, MD, FACS, Chair, ACS Committee on Trauma’s Best Practices Guidelines Committee.

The Spine Injury Best Practices Guidelines begins with the epidemiology of spinal injury, followed by reviews of prehospital spinal motion restriction, cervical collar clearance, and appropriate imaging. The volume also includes information on the following topics:

  • Completing a physical exam for evaluation of SCI
  • The classification systems for both spinal column injury and SCI
  • The indications for nonoperative and operative management for both blunt and penetrating spinal injuries
  • The use of mean arterial pressure-directed therapy and the limitations of its supporting data
  • Management of venous thromboembolism prophylaxis, neurogenic and spinal shock, SCI-induced bradycardia, ventilator management in a patient with high SCI, and analgesia.

The guidelines further address prevention and management of issues related to prolonged hospital care for spine injury patients and the importance of early mobilization and rehabilitation. Finally, the resource addresses implementation of the Spine Injury Best Practices Guidelines into trauma center protocols and integration of this information into a trauma center’s performance improvement processes.

The ACS Trauma Quality Programs Best Practices Guidelines are a valuable resource for trauma centers everywhere and provide healthcare professionals with recommendations regarding care of the trauma patient. Visit the ACS website at for more information on all the ACS Trauma Quality Programs Best Practices Guidelines.

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