List Archives

Wed Oct 1 16:18:38 BST 2008

The new (8e) edition of ATLS has a simple statement 'there is
insufficient evidence to support the use of steroids in spinal cord
injury'. This adds to the long held position of Dr Mattox that steroids
have no use in patients with these injuries.

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
Sent: Wednesday, October 01, 2008 9:34 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Early Acute Mgmt in Adults with SCI: Consortium for
SpinalCordMedicine Clinical Practice Guidelines(2008)

There is no quality difference expectations among Level I, II, and III
trauma centers.   

I hope we no longer are using steroids in pt w SCI.   I can find no
functional benefit in any paper from steroids in SCI.    

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: "Howard, Dot" <DotHoward at mhd.com>

Date: Wed, 1 Oct 2008 09:10:10 
To: <Trauma-List at Trauma.Org>
Subject: Early Acute Mgmt in Adults with SCI: Consortium for Spinal Cord
	Medicine Clinical Practice Guidelines(2008) 

Certainly it is an extraordinary gift to be provided an extensive
guideline by the specialists on management of any traumatic injury.

That being acknowledged, I am concerned about the information on page
one under "Trauma Centers". It notes that the patient should be
immediately transported to a "Level I trauma center as defined by
American College of Surgeons or by the state statute... consider taking
the patient directly to a Level I center if possible in preference to
passing through a Level II or III center first." 

The last time our facility as a Level II was reviewed, we were required
by ACS to meet the same standards for neurosurgical care as a Level I.
Is there another standard for acute care of the patient with spinal cord
injury for a I trauma center as defined" by the ACS which is different
than for the Level II centers? Should all Level IIs be bypassed for a
Level I center by EMS?

The guideline defers to the definition of an ACS' Level I, so was this
approved by the ACS Committee on Trauma or was any input sought from the
ACS? Have the ACS COT standards changed? 

Only those involved in treating the trauma patient in a level II can
understand the frustration dealing with ignorance that assumes that the
level of care provided for a particular injury is better or worse in a
center because it is a Level I or Level II.

Everyone in trauma care does understand that trauma care and especially
neurosurgical coverage for trauma patients is difficult nationwide and
to have a guideline to dictate that only a level I can manage these
cases narrows the already diminishing resources available.  

Thank you

***********************************************************************

This electronic transmission contains information from Methodist Health 
System and should be considered confidential and privileged.  The 
information contained in the above messages is intended only for the 
use of the individual(s) and entity(ies) named above.  If you are not 
the intended recipient, be aware that any disclosure, copying, 
distribution, or use of this information is prohibited. If you receive 
this transmission in error, please notify the sender immediately by 
return e-mail.  Methodist Health System, its subsidiaries and 
affiliates hereby claim all applicable privileges related to the 
transmission of this communication.
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Early Acute Mgmt in Adults with SCI: Consortium for SpinalCordMedicine Clinical Practice Guidelines(2008)