Management of patients with cervical spine trauma in the emergency department: a systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice

Public Awareness Levels Regarding Cervical Spine Injury and the Suitable First Aid Response Among Adults in Makkah, Saudi Arabia

Purpose

Cervical spine injuries (CSIs) are a growing concern, leading to severe and permanent disabilities. Educating the public about these injuries and appropriate emergency responses is crucial to prevent irreversible damage, minimize disability, and save lives, especially with the rising number of trauma victims worldwide. Herein, we assessed the awareness of CSIs, trauma identification, and first-aid procedures among adults in Makkah, Saudi Arabia.

Sample and Methods

This descriptive cross-sectional study included 591 participants aged 18 or older from Makkah, Saudi Arabia, selected using an online questionnaire and conducted between January and March 2024. We evaluated participants' knowledge and awareness levels about CSIs, analyzing variables such as personal data and first aid training using descriptive statistics, cross-tabulation, and Pearson chi-square tests.

Results

In total, 318 (53.8%) participants demonstrated good awareness of CSIs. Most (76.5%) identified road traffic accidents as a significant risk factor for CSIs. Additionally, 476 (80.5%) participants recognized that CSIs can involve spinal cord damage. Motor disability was acknowledged by 434 (73.9%) participants as a complication linked to CSIs, while 296 (50.1%) and 224 (37.9%) participants recognized sensory disability and respiratory problems as potential associated complications, respectively.

Conclusion

Our findings show that 53.8% of participants had an acceptable awareness level of CSIs, with road traffic accidents identified as the primary cause of spinal injuries. It is crucial to prioritize regular and organized public education and enforce strict road safety measures, particularly among the young, to mitigate the extensive physical, social, emotional, and economic consequences of this issue.

Towards clinical implementation of an AI-algorithm for detection of cervical spine fractures on computed tomography

BACKGROUND

Artificial intelligence (AI) applications can facilitate detection of cervical spine fractures on CT and reduce time to diagnosis by prioritizing suspected cases.

PURPOSE

To assess the effect on time to diagnose cervical spine fractures on CT and diagnostic accuracy of a commercially available AI application.

MATERIALS AND METHODS

In this study (June 2020 - March 2022) with historic controls and prospective evaluation, we evaluated regulatory-cleared AI-software to prioritize cervical spine fractures on CT. All patients underwent non-contrast CT of the cervical spine. The time between CT acquisition and the moment the scan was first opened (DNT) was compared between the retrospective and prospective cohorts. The reference standard for determining diagnostic accuracy was the radiology report created in routine clinical workflow and adjusted by a senior radiologist. Discrepant cases were reviewed and clinical relevance of missed fractures was determined.

RESULTS

2973 (mean age, 55.4 ± 19.7 [standard deviation]; 1857 men) patients were analyzed by AI, including 2036 retrospective and 938 prospective cases. Overall prevalence of cervical spine fractures was 7.6 %. The DNT was 18 % (5 min) shorter in the prospective cohort. In scans positive for cervical spine fracture according to the reference standard, DNT was 46 % (16 min) shorter in the prospective cohort. Overall sensitivity of the AI application was 89.8 % (95 % CI: 84.2-94.0 %), specificity was 95.3 % (95 % CI: 94.2-96.2 %), and diagnostic accuracy was 94.8 % (95 % CI: 93.8-95.8 %). Negative predictive value was 99.1 % (95 % CI: 98.5-99.4 %) and positive predictive value was 63.0 % (95 % CI: 58.0-67.8 %). 22 fractures were missed by AI of which 5 required stabilizing therapy.

CONCLUSION

A time gain of 16 min to diagnosis for fractured cases was observed after introducing AI. Although AI-assisted workflow prioritization of cervical spine fractures on CT shows high diagnostic accuracy, clinically relevant cases were missed.

Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey

BACKGROUND

Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings.

MATERIAL AND METHODS

An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols.

RESULTS

Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times).

CONCLUSION

We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country.

HOW TO CITE THIS ARTICLE

Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M et al. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023;27(1):38-51.

Quality evaluation of clinical practice guidelines for thromboprophylaxis in orthopaedic trauma based on AGREE II and AGREE-REX: a systematic review protocol

INTRODUCTION

Orthopaedic trauma patients are at high risk of venous thromboembolism (VTE). As VTE prophylaxis has gradually raised public concerns, guidelines related to this topic have increased over time. However, the existing recommendations of thromboprophylaxis guidelines in orthopaedic trauma patients are still inconsistent, and the quality of the guidelines and recommendations for the topic still lacks comprehensive assessments. This review aims to critically appraise clinical practice guidelines for thromboprophylaxis in orthopaedic trauma patients.

METHODS AND ANALYSIS

We will conduct a comprehensive literature search up to 31 October 2022 in databases (PubMed, EMBASE, CINAHL, Web of Science, the Cochrane Library, etc), academic websites and guideline repositories. The quality of the guidelines and recommendations will be assessed by five reviewers independently using the Appraisal of Guidelines Research and Evaluation II instrument (AGREE-II) and the AGREE - Recommendation EXcellence (AGREE-REX). We will summarise the characteristics of the guidelines and compare the differences between these recommendations.

ETHICS AND DISSEMINATION

This study will follow the Declaration of Helsinki and has received approval from the Ethics Committee on Biomedical Research, West China Hospital, Sichuan University (ethics approval no. 2021-989). The results will be summarised as a paper, disseminated through peer-reviewed journals, and will help guide further research in the future.

PROTOCOL REGISTRATION NUMBER

CRD42021273405.