Difficulties in the Initial Management of Spinal Trauma: A Survey of On-Call Trauma Surgeons in Argentina
Abstract
Introduction: This study aims to assess the difficulties encountered during the initial management of patients with spinal trauma, based on the experiences of on-call trauma surgeons in Argentina. Materials and Methods: We conducted a cross-sectional observational study of traumatologists working in emergency departments across Argentina. The objective was to identify challenges in the initial management of spinal trauma as perceived by these professionals. Data were collected using an online questionnaire distributed between March 1 and May 1, 2024. Results: A total of 261 professionals responded, the majority of whom were male (n = 210; 80.5%), with a mean age of 39.3 years (SD = 8.4; range: 26–68 years). Of the respondents, 67.4% were board-certified specialists. Responses were received from 22 of Argentina’s 23 provinces, with the majority coming from the province of Buenos Aires (n = 171; 65.5%), particularly the metropolitan area (n = 134; 51.3%). Over 70% of respondents reported encountering difficulties in various aspects of managing patients with spinal trauma. Conclusions: The experience reported by traumatologists working in emergency departments throughout Argentina reveals that more than 70% face significant and recurrent challenges in the care of patients with spinal trauma. Most respondents reported multiple difficulties, particularly regarding initial assessment, diagnostic evaluation, treatment, and timely referral.Downloads
References
Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol 2014;6:309-31. https://doi.org/10.2147/clep.s68889
Cao Y, Krause JS. Estimation of indirect costs based on employment and earnings changes after spinal cord injury: an observational study. Spinal Cord 2020;58(8):908-13. https://doi.org/10.1038/s41393-020-0447-1
DeVivo MJ, Chen Y, Mennemeyer ST, Deutsch A. Costs of care following spinal cord injury. Top Spinal Cord Inj Rehabil 2011;16(4):1-9. https://doi.org/10.1310/sci1604-1
Fernández Londoño LL, Marchesini N, Espejo Ballesteros D, Álzate García L, Gómez Jiménez JA, Ginalis E, et al. Epidemiological review of spinal cord injury due to road traffic accidents in Latin America. Med Princ Pract 2022;31(1):11-9. https://doi.org/10.1159/000520112
Giraldo YA, Castro JL, Tovar-Sánchez MA, Kumar AA, Pacichana-Quinayáz SG, Bonilla-Escobar FJ. Epidemiology of traumatic spinal cord injuries in Colombia. Spinal Cord Ser Cases 2021;7(1):42.
https://doi.org/10.1038/s41394-021-00408-3
Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, et al. Traumatic spinal cord injury. Nat Rev Dis Primers 2017;3:17018. https://doi.org/10.1038/nrdp.2017.18
National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance. J Spinal Cord Med 2013;36(1):1-2. https://doi.org/10.1179/1079026813Z.000000000136
Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte DW, Harrop JS, et al. Early versus delayed
decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One 2012;7(2):e32037. https://doi.org/10.1371/journal.pone.0032037
Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg 2009;4:9. https://doi.org/10.1186/1749-7922-4-9
Ministerio de Salud de la Nación. Marco de referencia para la formación de Residencias Médicas.
Especialidad: Ortopedia y Traumatología. Febrero 2019. Disponible en:
https://www.argentina.gob.ar/sites/default/files/marco_oyt_aprobado_nacional_para_cofesa_20190225.pd
f
Fehlings MG, Moghaddamjou A, Evaniew N, Tetreault LA, Alvi MA, Skelly AC, et al. The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What have we learned? What are the critical knowledge gaps and barriers to implementation? Global Spine J 2024;14(3_suppl):223S-230S.
https://doi.org/10.1177/21925682231196825
Fehlings MG, Hachem LD, Tetreault LA, Skelly AC, Dettori JR, Brodt ED, et al. Timing of decompressive surgery in patients with acute spinal cord injury: Systematic review update. Global Spine J 2024;14(3_suppl):38S-57S. https://doi.org/10.1177/21925682231197404
Marchesini N, Fernández Londoño LL, Griswold D, Rubiano AM. Early stages management of
traumatic spinal cord injury in Latin America: A scoping review. World Neurosurg 2022;162:138-49.e29. https://doi.org/10.1016/j.wneu.2022.03.021
Teles AR, Ramos MB, Righesso O, Falavigna A. Surgical timing in traumatic spinal cord injury: current practice and obstacles to early surgery in Latin America. Spinal Cord 2022;60(4):368-74.
https://doi.org/10.1038/s41393-022-00789-8
Burns AS, O’Connell C. The challenge of spinal cord injury care in the developing world. J Spinal Cord Med 2012;35(1):3-8. https://doi.org/10.1179/2045772311Y.0000000043
New PW, Cripps RA, Bonne Lee B. Global maps of non-traumatic spinal cord injury epidemiology:
towards a living data repository. Spinal Cord 2014;52(2):97-109. https://doi.org/10.1038/sc.2012.165
Guiroy A, Carazzo CA, Zamorano JJ, Cabrera JP, Joaquim AF, Guasque J, et al. Time to surgery for unstable Thoracolumbar fractures in Latin America-A multicentric study. World Neurosurg 2021;148:e488-e494. https://doi.org/10.1016/j.wneu.2021.01.010
Kwon BK, Tetreault LA, Martin AR, Arnold PM, Marco RAW, Newcombe VFJ, et al. A Clinical Practice Guideline for the Management of Patients with Acute Spinal Cord Injury: Recommendations on Hemodynamic Management. Global Spine J 2024;14(3_suppl):187S-211S. https://doi.org/10.1177/21925682231202348
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
