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Wed Oct 1 22:00:55 BST 2008

Pret:

I don't agree entirely with your statement.  There are several tangible advantages that a level 1 trauma center might hold over a level II/III.
1.  Immediate availability of spine MRI.  Which may change treatment in instances of spinal cord injury without CT evidence of trauma  (hot disc, acute on chronic disease, spinal epidural, or some other pathology which steers an algorithm toward a benefit of immediate decompression).
2.  Availability of spinal cord injury PMR specialists.

That's all I got.

Ben Reynolds, PA-C
Pittsburgh, PA

----- Original Message ----
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Wednesday, October 1, 2008 11:47:28 AM
Subject: RE: Early Acute Mgmt in Adults with SCI: Consortium for SpinalCordMedicine Clinical Practice Guidelines(2008)

If it helps (it did me), a link to the referenced reference may be found
here:

http://www.spinalcord.org/html/publications/publications_sci.php 

(Be sure to include the entire address if your email application wraps
the text)

Drill around and you should be able to locate (among many other
interesting-looking documents) a free .pdf for "Early Acute Management
in Adults with Spinal Cord Injury."

On page 13, you'll see a summary of recommendations.  Among these:
"Transfer the patient with a spinal cord injury as soon as possible to a
Level I trauma center, as defined by the American College of Surgeons or
by state statute."  It goes on to admit essentially that local protocols
vary and may properly direct the patient instead to a Level II center.
There's also qualifying language about spine centers and so forth.  But
the implication that a Level I has something special to offer these
patients is inescapable, and in the real world, flatly incorrect.

I don't see anything but discouragement for the use of steroids; but
that's just me skimming.

As for Dr. Mattox' assertions that Level III centers aspire to the same
quality expectations as Levels I and II, I suppose there's room for that
interpretation, depending on what exactly the terms "quality" and
expectations" entail.  What is clear is that the College's verification
process distinguishes Level I and II centers from Level III specific to
treatment of neurosurgical injury.  Level III's need not possess systems
or resources to manage acute neurosurgical emergencies, provided that
clear, functional, and effective relationships exist with centers that
do.

Pret Bjorn, RN
Bangor, ME USA

-----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 10:34 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

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