Specialisation of spinal services: consequences for cervical trauma management in the district hospital

Ulfin Rethnam¹ , James Cordell-Smith² and Amit Sinha¹

¹Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK

²Department of Orthopaedics, Morriston Hospital, Swansea, UK

author email corresponding author email

Journal of Trauma Management & Outcomes 2007, 1:6doi:10.1186/1752-2897-1-6


Published:	30 November 2007

Abstract

Background

Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre.

Methods

The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma.

Results

The response rate was 51/70 (73%). Nineteen of the hospitals (37%) did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 – 50%) were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization.

Conclusion

The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency.