Poor specificity of National Early Warning Score (NEWS) in spinal cord injuries (SCI) population: a retrospective cohort study.

STUDY DESIGN: Retrospective chart audit. OBJECTIVES: The National Early Warning Score (NEWS) is based on seven physiological parameters which can be altered in some individuals with spinal cord injuries (SCI). The aim was to start the development of adapted NEWS suitable for SCI population. The objective was to determine the SBP NEWS specificity based on neurological level of injury (NLI) and completeness of injury. SETTING: Tertiary centre in the UK. METHODS: Adult patients admitted for the first time to the National Spinal Injuries Centre between 1 January 2015 and 31 December 2016 were included if they were >6 months post injury. Data were extracted retrospectively including the last ten consecutive BP and heart rate readings before discharge. Data were analysed based on different AIS grades, completeness of injury and NLI. RESULTS: One hundred and ninety one patients were admitted in 2015 and 2016 and 142 patients were included in the primary analysis. The mean SBP ranged between 92 and 151 mmHg. Patients with the NLI of T6 and above (≥T6) motor complete lesions had a significantly lower SBP than motor incomplete lesions. The specificity of the SBP NEWS was 35.3% in ≥T6 motor complete individuals versus 80.3% in ≥T6 motor incomplete individuals. CONCLUSION: The baseline BP is significantly lower in the ≥T6 motor complete SCI individuals (>6 months post injury) resulting in a very low specificity of 35.3% to SBP NEWS, which could lead to mismatch between clinical deterioration and NEWS resulting in lack of timely clinical response.

Rapid incremental closed traction reduction of cervical facet fracture dislocation: the Stoke Mandeville experience.

STUDY DESIGN: Retrospective case series study. OBJECTIVE: To determine the success rate and neurological outcomes of rapid incremental closed traction reduction (RICTR) of cervical dislocations with spinal cord compression in the National Spinal Injuries Centre (NSIC), between June 2006 and December 2011. SETTING: Tertiary spinal injuries centre, Stoke Mandeville Hospital, UK. METHODS: A list of cervical trauma patients who were admitted to NSIC between January 2006 and December 2011 was retrieved from the hospital's electronic records, consultant and admission logbooks. Patients, admitted within 7 days of cervical facet dislocation and spinal cord injury (SCI), were included. Retrospective data collection and analysis was done using a data collection form and an Excel spreadsheet. RESULTS: Seventeen patients have met the eligibility criteria of the study. One patient was excluded because he only had nerve root symptoms. The procedure was successful in 44% of the cases. Eighty-six percent of patients in the successful RICTR group improved in their discharge motor index score (MIS), whereas 43% improved in their post-reduction MIS. Overall, 81% of the cohort had improvements in their discharge MIS. CONCLUSION: Our RICTR success rate was low compared to the reported average success rate in the literature, likely due to delays in admission. Neurological outcomes were favourable in the majority of patients at discharge. In our opinion, early admission and RICTR attempts could have improved the results and therefore we would recommend that RICTR procedures are done for suitable patients in the Emergency Departments of Major Trauma Centres (MTC).

One-year functional outcomes following major trauma: experience of a UK level 1 major trauma centre.

OBJECTIVE: To pilot a method for routine outcome data collection one year after admission to a major trauma centre, to determine current outcomes, and to identify possible methodological improvements. DESIGN: A postal questionnaire audit. SETTING: A major trauma centre in the United Kingdom. SUBJECTS: In total, 355 patients known to be alive 12 months after admission with major trauma (Injury Severity Score (ISS) of 9 or more). INTERVENTIONS: All patients received standard trauma and rehabilitation services available to them. MAIN MEASURES: The main measures used are as follows: ISS; EuroQol, five dimensions five levels (EQ-5D-5L); single questions about accommodation, mobility, and self-care; demographic and injury data collected from hospital records; and outcome data by postal questionnaire. RESULTS: In total, 429 patients were registered over six months: at one year, 64 had died and 10 had no UK address. In total, 355 questionnaires were sent out: 179 (50%) were never returned, 154 (43%) were returned with complete data, 11 forms were incomplete, 7 patients were dead, and 4 were not at the address contacted. Of the 154 with complete data, 91 had new mobility problems and 54 had new problems with personal activities. Of the 68 previously employed, 19 were unemployed, 38 were fully employed in the same job, and 13 had altered jobs. There was no association between Injury Severity Score and any of the outcome scores. CONCLUSION: A short simple questionnaire sent only once achieved a complete data set response rate of 43%. The outcome data are consistent with experience in other studies. Collection of data on specific functional outcomes might be most sensitive.