Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Edoardo Picetti¹, Andreas K Demetriades^{2

3}, Fausto Catena⁴, Bizhan Aarabi⁵, Fikri M Abu-Zidan⁶, Oscar L Alves⁷, Luca Ansaloni⁸, Rocco A Armonda⁹, Rafael Badenes¹⁰, Miklosh Bala¹¹, Zsolt J Balogh¹², Andrea Barbanera¹³, Alessandro Bertuccio¹⁴, Walter L Biffl¹⁴, Pierre Bouzat¹⁵, Andras Buki¹⁶, Ana Maria Castano-Leon¹⁷, Davide Cerasti¹⁸, Giuseppe Citerio^{19

20}, Federico Coccolini²¹, Raul Coimbra²², Carlo Coniglio²³, Francesco Costa²⁴, Federico De Iure²⁵, Bart Depreitere²⁶, Enrico Fainardi²⁷, Michael J Fehlings²⁸, Nikolay Gabrovsky²⁹, Daniel Agustin Godoy³⁰, Peter Gruen³¹, Deepak Gupta³², Gregory W J Hawryluk³³, Raimund Helbok^{34

35}, Iftakher Hossain^{36

37}, Peter J Hutchinson³⁷, Corrado Iaccarino³⁸, Kenji Inaba³⁹, Marcel Ivanov⁴⁰, Stanislav Kaprovoy⁴¹, Andrew W Kirkpatrick⁴², Sam Klein^{43

44}, Angelos Kolias^{37

45

46}, Nikolay A Konovalov⁴¹, Alfonso Lagares¹⁷, Laura Lippa⁴⁷, Angelica Loza-Gomez⁴⁸, Teemu M Luoto⁴⁹, Andrew I R Maas^{50

51}, Andrzej Maciejczak⁵², Ronald V Maier⁵³, Niklas Marklund^{54

55}, Matthew J Martin⁵⁶, Ilaria Melloni⁵⁷, Sergio Mendoza-Lattes⁵⁸, Geert Meyfroidt⁵⁹, Marina Munari⁶⁰, Lena M Napolitano⁶¹, David O Okonkwo⁶², Yasuhiro Otomo⁶³, Marios C Papadopoulos⁶⁴, Ondra Petr⁶⁵, Wilco C Peul³, Aichholz K Pudkrong⁶⁶, Zaffer Qasim⁴⁸, Frank Rasulo⁶⁷, Carla Reizinho⁶⁸, Florian Ringel⁶⁹, Sandro Rizoli⁷⁰, Elham Rostami⁷¹, Andres M Rubiano⁷², Emanuele Russo⁷³, Aarti Sarwal⁷⁴, Jan M Schwab⁷⁵, Franco Servadei⁷⁶, Deepak Sharma⁷⁷, Salman Sharif⁷⁸, Ehab Shiban⁷⁹, Lori Shutter⁸⁰, Philip F Stahel⁸¹, Fabio S Taccone⁸², Nicole A Terpolilli⁸³, Claudius Thomé⁶⁵, Peter Toth⁸⁴, Parmenion P Tsitsopoulos⁸⁵, Andrew Udy⁸⁶, Alexander R Vaccaro⁸⁷, Albert J Varon⁸⁸, Monica S Vavilala⁶⁶, Alexander Younsi⁸⁹, Monika Zackova⁹⁰, Tommaso Zoerle⁹¹, Chiara Robba⁹²

Affiliations

¹ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. edoardopicetti@hotmail.com.
² Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, UK.
³ Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands.
⁴ Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
⁵ Department of Neurosurgery, University of Maryland, Baltimore, MD, USA.
⁶ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
⁷ Hospital Lusíadas Porto, Centro Hospitalar de Gaia/Espinho, Porto, Portugal.
⁸ Department of Surgery, Pavia University Hospital, Pavia, Italy.
⁹ Department of Neurosurgery, Georgetown University School of Medicine and MedStar Washington Hospital Center, Washington, DC, USA.
¹⁰ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain.
¹¹ Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹² Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia.
¹³ Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy.
¹⁴ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁵ Universite Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
¹⁶ School of Medical Sciences, Örebro University, Örebro, Sweden.
¹⁷ Neurosurgery Department, University Hospital "12 de Octubre", Madrid, Spain.
¹⁸ Neuroradiology Unit, Parma University Hospital, Parma, Italy.
¹⁹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
²⁰ Department of Neuroscience, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
²¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
²² Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Riverside, CA, USA.
²³ Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
²⁴ Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
²⁵ Department of Spine Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
²⁶ Department of Neurosurgery, University Hospital KU Leuven, Louvain, Belgium.
²⁷ Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
²⁸ Division of Neurosurgery, Department of Surgery, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.
²⁹ Clinic of Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria.
³⁰ Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
³¹ Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.
³² Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
³³ Neurological Institute, Cleveland Clinic, Akron General Hospital, Fairlawn, OH, USA.
³⁴ Department of Neurology, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.
³⁵ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
³⁶ Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland.
³⁷ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
³⁸ Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
³⁹ Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
⁴⁰ Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, UK.
⁴¹ Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia.
⁴² Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
⁴³ Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium.
⁴⁴ Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.
⁴⁵ ANAPLASI Rehabilitation Centre, Athens, Greece.
⁴⁶ 1St Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece.
⁴⁷ Department of Neurosurgery, Ospedale Niguarda, Milan, Italy.
⁴⁸ Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴⁹ Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland.
⁵⁰ Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
⁵¹ Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
⁵² Department of Neurosurgery, St Luke Hospital, University of Rzeszow, Tarnow, Poland.
⁵³ Department of Surgery, University of Washington, Seattle, WA, USA.
⁵⁴ Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden.
⁵⁵ Department of Neurosurgery, Skåne University Hospital, Lund, Sweden.
⁵⁶ University of Southern California, Los Angeles, CA, USA.
⁵⁷ Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁵⁸ Department of Orthopaedics, Duke University, Durham, NC, USA.
⁵⁹ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Louvain, Belgium.
⁶⁰ Neuro-Intensive Care Unit, University Hospital of Padova, Padua, Italy.
⁶¹ Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
⁶² Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁶³ National Disaster Medical Center, Tokyo, Japan.
⁶⁴ Academic Neurosurgery Unit, St. George's, University of London, London, UK.
⁶⁵ Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
⁶⁶ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
⁶⁷ Department of Neuroanesthesia and Neurocritical Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy.
⁶⁸ Departamento de Neurocirurgia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
⁶⁹ Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
⁷⁰ Trauma Surgery Department, Hamad General Hospital, HMC, Doha, Qatar.
⁷¹ Section of Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁷² Neurosciences Institute, El Bosque University, Bogotá, Colombia.
⁷³ Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy.
⁷⁴ Department of Neurology, Atrium Wake Forest School of Medicine, Winston Salem, NC, USA.
⁷⁵ Belford Center for Spinal Cord Injury and Departments of Neurology and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
⁷⁶ Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy.
⁷⁷ Neuroanesthesia & Perioperative Neuroscience, University of Washington, Seattle, WA, USA.
⁷⁸ Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
⁷⁹ Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
⁸⁰ Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁸¹ Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
⁸² Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁸³ Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Munich, Germany.
⁸⁴ Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary.
⁸⁵ Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloníki, Greece.
⁸⁶ Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia.
⁸⁷ Department of Orthopedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Orthopedics, Sidney Kimmel Medical Center of Thomas Jefferson University, Philadelphia, PA, USA.
⁸⁸ Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, FL, USA.
⁸⁹ Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
⁹⁰ Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy.
⁹¹ Department of Pathophysiology and Transplantation, University of Milan, Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁹² IRCCS Policlinico San Martino, Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, Università di Genova, Genoa, Italy.

PMID: 38238783
PMCID: PMC10795357
DOI: 10.1186/s13017-023-00525-4

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Edoardo Picetti et al. World J Emerg Surg. 2024.

. 2024 Jan 18;19(1):4.

doi: 10.1186/s13017-023-00525-4.

Authors

Affiliations

¹ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. edoardopicetti@hotmail.com.
² Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, UK.
³ Leiden University Neurosurgical Centre Holland, HMC-HAGA The Hague & LUMC Leiden, Leiden, The Netherlands.
⁴ Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
⁵ Department of Neurosurgery, University of Maryland, Baltimore, MD, USA.
⁶ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
⁷ Hospital Lusíadas Porto, Centro Hospitalar de Gaia/Espinho, Porto, Portugal.
⁸ Department of Surgery, Pavia University Hospital, Pavia, Italy.
⁹ Department of Neurosurgery, Georgetown University School of Medicine and MedStar Washington Hospital Center, Washington, DC, USA.
¹⁰ Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain.
¹¹ Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
¹² Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia.
¹³ Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy.
¹⁴ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁵ Universite Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France.
¹⁶ School of Medical Sciences, Örebro University, Örebro, Sweden.
¹⁷ Neurosurgery Department, University Hospital "12 de Octubre", Madrid, Spain.
¹⁸ Neuroradiology Unit, Parma University Hospital, Parma, Italy.
¹⁹ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
²⁰ Department of Neuroscience, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
²¹ General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
²² Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Riverside, CA, USA.
²³ Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
²⁴ Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, University of Milan, Milan, Italy.
²⁵ Department of Spine Surgery, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
²⁶ Department of Neurosurgery, University Hospital KU Leuven, Louvain, Belgium.
²⁷ Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
²⁸ Division of Neurosurgery, Department of Surgery, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.
²⁹ Clinic of Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria.
³⁰ Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
³¹ Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA.
³² Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
³³ Neurological Institute, Cleveland Clinic, Akron General Hospital, Fairlawn, OH, USA.
³⁴ Department of Neurology, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.
³⁵ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
³⁶ Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland.
³⁷ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
³⁸ Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
³⁹ Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
⁴⁰ Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, UK.
⁴¹ Department of Spinal and Peripheral Nerve Surgery Burdenko Neurosurgical Center, Moscow, Russia.
⁴² Departments of Surgery and Critical Care Medicine, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
⁴³ Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium.
⁴⁴ Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.
⁴⁵ ANAPLASI Rehabilitation Centre, Athens, Greece.
⁴⁶ 1St Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece.
⁴⁷ Department of Neurosurgery, Ospedale Niguarda, Milan, Italy.
⁴⁸ Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴⁹ Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland.
⁵⁰ Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
⁵¹ Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
⁵² Department of Neurosurgery, St Luke Hospital, University of Rzeszow, Tarnow, Poland.
⁵³ Department of Surgery, University of Washington, Seattle, WA, USA.
⁵⁴ Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, Sweden.
⁵⁵ Department of Neurosurgery, Skåne University Hospital, Lund, Sweden.
⁵⁶ University of Southern California, Los Angeles, CA, USA.
⁵⁷ Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁵⁸ Department of Orthopaedics, Duke University, Durham, NC, USA.
⁵⁹ Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Louvain, Belgium.
⁶⁰ Neuro-Intensive Care Unit, University Hospital of Padova, Padua, Italy.
⁶¹ Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
⁶² Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁶³ National Disaster Medical Center, Tokyo, Japan.
⁶⁴ Academic Neurosurgery Unit, St. George's, University of London, London, UK.
⁶⁵ Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
⁶⁶ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
⁶⁷ Department of Neuroanesthesia and Neurocritical Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy.
⁶⁸ Departamento de Neurocirurgia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
⁶⁹ Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
⁷⁰ Trauma Surgery Department, Hamad General Hospital, HMC, Doha, Qatar.
⁷¹ Section of Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁷² Neurosciences Institute, El Bosque University, Bogotá, Colombia.
⁷³ Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy.
⁷⁴ Department of Neurology, Atrium Wake Forest School of Medicine, Winston Salem, NC, USA.
⁷⁵ Belford Center for Spinal Cord Injury and Departments of Neurology and Neuroscience, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
⁷⁶ Humanitas Research Hospital-IRCCS & Humanitas University, Rozzano, Milan, Italy.
⁷⁷ Neuroanesthesia & Perioperative Neuroscience, University of Washington, Seattle, WA, USA.
⁷⁸ Department of Neurosurgery, Liaquat National Hospital, Karachi, Pakistan.
⁷⁹ Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
⁸⁰ Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁸¹ Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
⁸² Department of Intensive Care, Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
⁸³ Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Munich, Germany.
⁸⁴ Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary.
⁸⁵ Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloníki, Greece.
⁸⁶ Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia.
⁸⁷ Department of Orthopedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Orthopedics, Sidney Kimmel Medical Center of Thomas Jefferson University, Philadelphia, PA, USA.
⁸⁸ Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine/Ryder Trauma Center, Miami, FL, USA.
⁸⁹ Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
⁹⁰ Division of Intensive Care and Neurology Unit, Montecatone Rehabilitation Institute, Imola, Italy.
⁹¹ Department of Pathophysiology and Transplantation, University of Milan, Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁹² IRCCS Policlinico San Martino, Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, Università di Genova, Genoa, Italy.

PMID: 38238783
PMCID: PMC10795357
DOI: 10.1186/s13017-023-00525-4

Abstract

Background: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies.

Methods: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted.

Results: A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak).

Conclusions: This consensus provides practical recommendations to support a clinician's decision making in the management of tSCI polytrauma patients.

Keywords: Management; Polytrauma; Traumatic spinal cord injury.

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Conflict of interest statement

AWK serves as the PI of the COOL trial, which previously was partially supported by the 3M/Acelity Corporation until August 2022. AWK is also a member of the Canadian Forces Medical Services and has consulted for the 3M/Acelity Corporation, Zoll Medical, Innovative Trauma Care and CSL Behring. AWK is the Director of the TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research group and serves in the Canadian Forces Medical Services. IH receives funding from the Finnish Medical Foundation, the Päivikki and Sakari Sohlberg Foundation, the Paulo Foundation and the Finnish Cultural Foundation. PJH is supported by the UK NIHR-Senior Investigator Award, Cambridge BRC, Brain Injury Medtech Co-operative, Global Health Research Group on Acquired Brain and Spine Injury and the Royal College of Surgeons of England.

Figures

**Fig. 1**
Consensus flowchart. **(1)** intubation, mechanical ventilation, hemodynamic support, extraspinal surgery/interventional radiology for bleeding control, etc. **(2)** In case of difficult intraoperative bleeding control, lower values could be tolerated for the shortest possible time. **(3)** higher values in patients "at risk" (e.g., elderly and/or with limited cardiovascular reserve because of pre-existing heart disease, etc.). **(4)** if available (e.g., TEG, ROTEM, etc.). **(5)** as utilized in NABISC I-III studies. **(6)** in order to determine the severity of spinal cord damage and aid in surgical decision making. **(7)** decompression and/or stabilization. tSCI = Traumatic spinal cord injury, CT = Computed tomography, MRI = Magnetic resonance imaging, MAP = Mean arterial pressure, Hb = Hemoglobin, PaO₂ = Arterial partial pressure of oxygen, PaCO₂ = Arterial partial pressure of carbon dioxide, PLT = Platelet, PT = Prothrombin time, aPTT = Activated partial thromboplastin time, POC = Point-of-care, P = Plasma, RBC = Red blood cell, MT = Massive transfusion, DVT = Deep vein thrombosis, IPCD = Intermittent pneumatic compression device

See this image and copyright information in PMC

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Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Affiliations

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical