title: Pre-hospital and acute management of traumatic spinal cord injury in the Netherlands: survey results urge the need for standardisation.
abstract: METHODS
  Questionnaire survey.
  
  
  OBJECTIVE
  Although a range of novel therapeutic approaches for traumatic spinal cord injury (tSCI) are being trialled in highly standardised, pre-clinical research models, little has been published about the extent of standardisation in health service delivery for newly injured tSCI patients.
  
  
  METHODS
  All Emergency Medical Services (EMSs) and 11 level-1 trauma centres (L1TCs) in the Netherlands.
  
  
  METHODS
  A survey assessing the organisation of pre-hospital and acute tSCI management was developed and distributed across all 23 pre-hospital EMSs and 11 L1TCs based in the Netherlands.
  
  
  RESULTS
  Response rates for EMSs and L1TCs were 82 and 100%, respectively. Thirteen EMSs (68%) transported all patients who are suspected of having tSCI to L1TCs. The decision to transfer tSCI patients to L1TCs was primarily made by paramedics at the scene of accident (79%). Nonetheless, no EMS reported the use of validated neurological assessments for determining the likelihood of tSCI. The International Standards for Neurological Classification of SCI were used to determine the level and severity of tSCI in four centres, and three centres performed magnetic resonance imaging in all tSCI patients. Three L1TCs had spinal cord perfusion support protocols in place, and two centres administered methylprednisolon to acute tSCI patients.
  
  
  CONCLUSIONS
  We found a large variance in the delivery of pre-hospital and acute tSCI management in a well-defined geographical catchment area. This survey urges the need for implementing standardised assessments and developing best-practice guidelines, which should be endorsed by all pre-hospital and acute tSCI health-care providers.
authors.affiliation: Department of Orthopaedic Surgery, Radboudumc, Nijmegen, The Netherlands.|Department of Orthopaedic Surgery, CORAL-Centre for Orthopaedic Research Alkmaar, Medical Centre Alkmaar, Alkmaar, The Netherlands.
authors.forename: B L
authors.initials: BL
authors.lastname: Fransen
authors.affiliation: Department of Orthopaedic Surgery, Radboudumc, Nijmegen, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hosman
authors.affiliation: Department of Rehabilitation Medicine, Stoke Mandeville Spinal Foundation, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Middendorp
authors.affiliation: Department of Traumasurgery, Radboudumc, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Regional Ambulance Service Gelderland-Zuid, Nijmegen, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Department of Rehabilitation Medicine, Radboudumc, Nijmegen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van de Meent
mesh_terms: D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002985:Clinical Protocols / Q000592:standards; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D009426:Netherlands; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data