The Development of Major Trauma Centers in the United Kingdom: First Year of Operation of a New Neurotrauma Center at the Imperial College NHS Trust in London. Problems and Pitfalls of Setting up an Acute Spinal Service

Objective: St Mary’s Hospital (part of Imperial NHS Trust) was designated as a new Major Trauma Centre for adult patients in London and went live in January 2011. Before this, St Mary’s Hospital had a small acute spinal service, and some other acute services were missing. The process of establishing a new spinal trauma service required additional staff, equipment, training, and resources. This included one senior spinal surgeon (orthopedic background), three part time spinal surgeons (neurosurgical background), and two spinal fellows. The acute spinal service has two spinal trauma MDT meetings on Tuesday and on Friday. The main theater list is on Monday and sharing of the emergency hospital list during the rest of the week.

Methods: Between January 2011 and January 2012, 201 spinal cases were admitted. The study has detailed analysis into the spinal cases, mechanism of injury, associated injuries, type of spinal fractures, length of stay, and treatment given. The study also highlights some of the difficulties encountered setting up an acute spinal service, including problems with specialized medical staffing, out of hours imaging service, nursing issues, on call service, physiotherapy, theatre availability, and other logistical issues.

Results: From January 2011 to January 2012, the emergency service received 1807 trauma calls of which 201 were spinal patients (66 were females and 135 males; age range 4 to 95 years) average 53 years; mean of 44 due to RTA, 56 due to falls, and 101 unknown/other injuries/pathology.

Of the 201 patients, 71 had cervical spine pathology (9 combined cervical and thoracic injuries), 36 had thoracic pathology (2 combined thoracic and lumbar injuries), 89 had lumbar pathology, 1 sacral, and 3 normal. There were 11 patients who had more than one location of fractures.

76 had various surgical and radiological interventions. Other injuries included 702 with head injury.

A total of 79 pediatric cases were admitted to hospital. Of these there were 32 children with head injuries and 3 with spinal injuries. Among these children, two required emergency surgery before transfer to Great Ormond Street Hospital.

There were problems with getting enough specialized spinal staff to provide a full spinal on call service. Also problems were encountered with repatriation to the spinal injury units at Stanmore and Stoke Mandeville.

Conclusion: The establishment of a functioning isolated neurotrauma service is possible, although there are some problems.