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Management of traumatic spinal cord injury in the Nordic countries : a multidisciplinary survey

Feyling, Anders C. ; Undén, Johan LU ; Marklund, Niklas LU orcid ; Malak, Ilke ; Åstrand, Ramona LU ; Posti, Jussi P. and Brommeland, Tor (2025) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 33(1).
Abstract

Background: Management of traumatic spinal cord injury is complex and depends on a multidisciplinary approach involving pre-hospital services, spinal surgery, intensive care unit treatment and specialized rehabilitation. International clinical practice guidelines for the handling of these patients offer specific recommendations regarding transportation, radiological investigations, timing of surgery, intensive care management and rehabilitation. We performed a comprehensive multicenter survey to assess the agreement between the Nordic countries on the different aspects of traumatic spinal cord injury management. Methods: Sequential, cross-sectional, structured survey comprising the key clinical domains (pre-hospital services, spinal... (More)

Background: Management of traumatic spinal cord injury is complex and depends on a multidisciplinary approach involving pre-hospital services, spinal surgery, intensive care unit treatment and specialized rehabilitation. International clinical practice guidelines for the handling of these patients offer specific recommendations regarding transportation, radiological investigations, timing of surgery, intensive care management and rehabilitation. We performed a comprehensive multicenter survey to assess the agreement between the Nordic countries on the different aspects of traumatic spinal cord injury management. Methods: Sequential, cross-sectional, structured survey comprising the key clinical domains (pre-hospital services, spinal surgery, intensive care management and rehabilitation) in all tertiary spine trauma centers in Sweden, Denmark, Norway, Iceland and Finland. Data are presented descriptively. Results: A total of 109 respondents from 22 Nordic centers were invited to take the survey, with a response rate of 90% (98/109). Overall, clinical practices were comparable within the domains. Prehospital services had similar practices for airway management, clinical spine clearance and patient transport. Preoperative magnetic resonance imaging was available to 33/35 of the spine surgeons (94%) on a 24/7 basis. This examination was considered mandatory prior to surgery by 66% (23/35) of the surgeons. Surgery was defined as early if performed within 24 h of the injury by all surveyed surgeons. Augmented blood pressure regimens were widely applied in the intensive care units, with mean arterial pressure targets varying between > 80 and > 90 mmHg. Postoperative thromboprophylaxis was administered within 48 h by all centers and rehabilitation policies were similar overall. Notable variations in practice were the occasional steroid administration and the use of lumbar drains in 54% (14/26) of intensive care units. Conclusion: Although there is some variability in the current management of traumatic spinal cord injury in the Nordic countries at the center- and country-level, practices in most key clinical domains are similar and follow established international guidelines.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical management, Spinal cord injury, Survey
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
33
issue
1
article number
51
publisher
BioMed Central (BMC)
external identifiers
  • pmid:40128803
  • scopus:105000812478
ISSN
1757-7241
DOI
10.1186/s13049-025-01349-8
language
English
LU publication?
yes
id
620e44db-c936-4ade-87f9-bef215ae75da
date added to LUP
2025-08-06 09:50:44
date last changed
2025-08-06 09:51:06
@article{620e44db-c936-4ade-87f9-bef215ae75da,
  abstract     = {{<p>Background: Management of traumatic spinal cord injury is complex and depends on a multidisciplinary approach involving pre-hospital services, spinal surgery, intensive care unit treatment and specialized rehabilitation. International clinical practice guidelines for the handling of these patients offer specific recommendations regarding transportation, radiological investigations, timing of surgery, intensive care management and rehabilitation. We performed a comprehensive multicenter survey to assess the agreement between the Nordic countries on the different aspects of traumatic spinal cord injury management. Methods: Sequential, cross-sectional, structured survey comprising the key clinical domains (pre-hospital services, spinal surgery, intensive care management and rehabilitation) in all tertiary spine trauma centers in Sweden, Denmark, Norway, Iceland and Finland. Data are presented descriptively. Results: A total of 109 respondents from 22 Nordic centers were invited to take the survey, with a response rate of 90% (98/109). Overall, clinical practices were comparable within the domains. Prehospital services had similar practices for airway management, clinical spine clearance and patient transport. Preoperative magnetic resonance imaging was available to 33/35 of the spine surgeons (94%) on a 24/7 basis. This examination was considered mandatory prior to surgery by 66% (23/35) of the surgeons. Surgery was defined as early if performed within 24 h of the injury by all surveyed surgeons. Augmented blood pressure regimens were widely applied in the intensive care units, with mean arterial pressure targets varying between &gt; 80 and &gt; 90 mmHg. Postoperative thromboprophylaxis was administered within 48 h by all centers and rehabilitation policies were similar overall. Notable variations in practice were the occasional steroid administration and the use of lumbar drains in 54% (14/26) of intensive care units. Conclusion: Although there is some variability in the current management of traumatic spinal cord injury in the Nordic countries at the center- and country-level, practices in most key clinical domains are similar and follow established international guidelines.</p>}},
  author       = {{Feyling, Anders C. and Undén, Johan and Marklund, Niklas and Malak, Ilke and Åstrand, Ramona and Posti, Jussi P. and Brommeland, Tor}},
  issn         = {{1757-7241}},
  keywords     = {{Clinical management; Spinal cord injury; Survey}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}},
  title        = {{Management of traumatic spinal cord injury in the Nordic countries : a multidisciplinary survey}},
  url          = {{http://dx.doi.org/10.1186/s13049-025-01349-8}},
  doi          = {{10.1186/s13049-025-01349-8}},
  volume       = {{33}},
  year         = {{2025}},
}