title: A multi-centred audit of secondary spinal assessments in a trauma setting: are we ATLS compliant?
abstract: OBJECTIVE
  The global incidence of spinal cord injuries varies with the developed world having improved survival and 1 year mortality in a poly-trauma setting. This improved survival has been estimated at 20 % in a recent Cochrane review of Advanced Trauma Life Support (ATLS).The aim of this audit is to evaluate the management of patients with suspected spinal cord injury by the trauma and orthopaedic team in three centres in South Wales.
  
  
  METHODS
  A retrospective case note review of the secondary survey was performed. Inclusion criteria were patients 18 years and above, with poly-trauma and presenting to Accident and Emergency department at the treating hospital. We used ATLS guidelines as an audit tool and reviewed the documentation of key components of the secondary assessment.
  
  
  RESULTS
  Forty-nine patients were included (29 males, 20 females) with an average age of 53.7 years (19-92 years). We found that completion of all components of the secondary survey for spinal injury was poor, 29 % receiving a digital per rectal examination despite suspected spinal injury. Paralysis level was not documented in 20.4 % of patients. Medical Research Council grade was only documented in 24.5 % although was assessed in 73.5 %. The secondary survey took place after 2 h in 54.6 % of patients.
  
  
  CONCLUSIONS
  We found that the documentation of the performance of a secondary survey was poor. We found that most patients included in this study are not currently meeting the minimal standard suggested by the ATLS guidelines.
authors.affiliation: Welsh Institute of Spinal Injuries, University Hospital of Wales, Cardiff, UK, brooks.francis@gmail.com.
authors.forename: Francis
authors.initials: F
authors.lastname: Brooks
authors.forename: Alexander
authors.initials: A
authors.lastname: Clark
authors.forename: Ryan
authors.initials: R
authors.lastname: O'Neil
authors.forename: Catherine
authors.initials: C
authors.lastname: James
authors.forename: Catehrine
authors.initials: C
authors.lastname: Power
authors.forename: Mia
authors.initials: M
authors.lastname: Gillett
authors.forename: Sebastian
authors.initials: S
authors.lastname: Tindall
authors.forename: Ganiy
authors.initials: G
authors.lastname: Abdulrahman
authors.forename: Claire
authors.initials: C
authors.lastname: Murray
authors.forename: Sashin
authors.initials: S
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D061906:Advanced Trauma Life Support Care / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards; D004282:Documentation / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy; D009460:Neurologic Examination / Q000592:standards; D009985:Orthopedics / Q000592:standards; D010808:Physical Examination / Q000592:standards; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000628:therapy*; D014193:Trauma Centers / Q000592:standards*; D014852:Wales; D055815:Young Adult