Impact d'une démarche d'amélioration des pratiques dans la prise en charge du traumatisme du rachis cervical au SAU de la Timone

Abstract : Introduction: Evaluating and improving the medical care of the cervical spine injury (CSI) in the ED of the Timone 2. Methods: A first retrospective study based on 195 patients in January 2016 outlined the medical care of the CSI. The malfunctions identified resulted in a new service charter, which was studied in a second prospective study based on 210 patients in May 2017. Both samples were then compared. Exclusion criteria were patients receiving whole body CT-scan and the non-cervical spine injury. Results: The new protocol improved the medical care of patients over the age of 65 with a CSI. Radiological quality was not improved. More flexible cervical collars (p = 0.08), dynamic imaging (p = 0.869) and post-emergency consultations (p <0.001) were prescribed. A persistent shortage of new x-rays and CT-scans were underlined when the x-rays views were of poor quality. Fewer patients were discharged with an unseen cervico-thoracic junction (p= 0.173). Discussion: The limit of radiography emerges from this study. The prescription of a CT-scan, from the outset for patients over the age of 65, or after first X-rays of poor quality for younger patients, is essential. Post-emergency monitoring and dynamic imaging should be systematized. Conclusion: An improvement in the quality of the medical care of the CSI appears.
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https://dumas.ccsd.cnrs.fr/dumas-02043574
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Damien Perruchetti. Impact d'une démarche d'amélioration des pratiques dans la prise en charge du traumatisme du rachis cervical au SAU de la Timone. Sciences du Vivant [q-bio]. 2017. ⟨dumas-02043574⟩

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