Les lésions traumatiques de la moelle épinière : épidémiologie et prise en charge pré-hospitalière

Evaluating prehospital care of patients with potential traumatic spinal cord injury: scoping review

PURPOSE

To gain insight into current research regarding prehospital care (PHC) in patients with potential traumatic spinal cord injury (TSCI) and to disseminate the findings to the research community.

METHODS

In March 2019, we performed a literature search of publications from January 1990 to March 2019 indexed in PubMed, gray literature including professional websites; and reference sections of selected articles for other relevant literature. This review was performed according to Arksey and O'Malley's framework.

RESULTS

There were 42 studies selected based on the inclusion criteria for review; 18 articles regarding immobilization; 12 articles regarding movement, positioning and transport; four for spinal clearance; three for airway protection; and two for the role of PHC providers. There were some articles that covered two topics: one article was regarding movement, positioning and transport and airway protection, and two were regarding spinal clearance and the role of PHC providers.

CONCLUSION

There was no uniform opinion about spinal immobilization of patients with suspected TSCI. The novel lateral trauma position and one of two High Arm IN Endangered Spine (HAINES) methods are preferred methods for unconscious patients. Controlled self-extrication for patients with stable hemodynamic status is recommended. Early and proper identifying of potential TSCI by PHC providers can significantly improve patients' outcomes and can result in avoiding unwanted spinal immobilization. Future prospective studies with a large sample size in real-life settings are needed to provide clear and evidence-based data in PHC of patients with suspected TSCI.

Actual incidences of road casualties, and their injury severity, modelled from police and hospital data, France

BACKGROUND

Nation-wide road casualty figures usually come from police data. In France, as in many developed countries, the reporting of fatalities is almost complete but the reporting of non-fatal casualties is rather low. It is moreover strongly biased. Valid estimates are needed.

METHODS

Using the capture-recapture method on police data and on a road trauma registry covering a large county of 1.6 million inhabitants, we estimate police under-reporting correction factors that account for unregistered casualties. These correction factors are then applied to the nation-wide police data, with standardization on under-reporting bias factors.

RESULTS

In 2004, whereas the police report 108,727 non-fatally injured, the estimation yields 400,200. Over the 1996-2004 study period, the average annual estimated incidence is 871/100,000 for all injured (3.4 times the police incidence), 232/100,000 for hospitalized, 103/100,000 for seriously injured (2.2 times the police incidence) and 12.6/100,000 for casualties with long-term major impairment. The incidence of seriously injured (NISS 9+) is 11.3/100,000 for pedestrians, 9.5/100,000 for cyclists, 36.3/100,000 for motorized two-wheel users and 42.5/100,000 for car users.

CONCLUSIONS

The estimated incidences are much higher than the police-based ones. This changes the scale of the road injuries issue. The risk of suffering a major impairment from a road crash is equal to the risk of being killed. Motorized two-wheel users experience a large burden of traffic casualties, much larger than that indicated by police data. The approach used can be reproduced in other countries, if an additional medical registration exists.