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CONCISEGUIDANCETO GOODPRACTICE
Aseriesofevidence-basedguidelinesforclinicalmanagement
NUMBER9
Chronicspinalcordinjury:managementof patientsinacutehospitalsettingsNATIONALGUIDELINES
February2008 BASCIS
http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.mascip.co.uk/http://www.bsrm.co.uk/http://www.rcplondon.ac.uk/7/27/2019 Concise Chronic Spinal Cord Injury 2008
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http://www.spinal.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.mascip.co.uk/http://www.bsrm.co.uk/7/27/2019 Concise Chronic Spinal Cord Injury 2008
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Contents
GuidelineDevelopmentGroup ii
Usefulsourcesofinformation ii
Introductionandaimoftheguidelines 1
PathophysiologicalconsequencesofSCI
Respiratory 2
Cardiovascular 2
Neurological 4
References 4
Furtherreading 4
THEGUIDELINES
A Staffawarenessandtraining 7
B Assessmentofpatients withspinalcordinjury 8
C Managementofpatients withspinalcordinjury 9
Appendices
1 Guidelinedevelopmentprocess 10
2 Levelsofevidence 11
3 Checkli stforassessmentandmanagementof
individuals withestablishedSCI 12
4 Spinalcordinjurycentres 13
Introductionandaimof
the guidelines
Traumaticspinalcordinjury(SCI)intheUKaffects
anestimated1015peoplepermillionpopulation
peryear1 sotherearearound40,000individualsin
theUKlivingwithatraumaticSCI.2 Mostinjuries
areinyoungmenbutthemeanageofinjuryis
increasing,includingthoseinjuredovertheageof60
years.Themajorityofinjuriesnowresultin
tetraplegiaandarepredominantlyincomplete
injuries.Theprevalenceofother conditions causing
SCIsuchasinflammatory,neoplastic andinfective
conditionsis currentlyunknown.
ThelifeexpectancyforpeoplewithSCIislessthan
forthegeneralpopulationalthoughit continuesto
increase.Theseindividualsarethereforeatriskfrom
age-relateddiseasesthataffectthegeneral
population,including cardiovasculardisease,
infectionandmalignancies.Also,themultisystem
impairmentsresultingfromSCI canleadtoseveral
complications,particularlyinfections,respiratory
complicationsandpressuresores.Those withSCIare
RoyalCollegeofPhysiciansofLondon
11 StAndrewsPlace,LondonNW1 4LE
www.rcplondon.ac.uk
RegisteredCharityNo 210508
ISBN 978-1-86016-324-1
DesignedandtypesetbythePublicationsUnitoftheRoyal
CollegeofPhysicians
PrintedinGreat BritainbyTheLavenhamGroupLtd,Suffolk
Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 1
Spinalcordinjury(SCI)isalifelongcondition
affectingover 40,000 peopleintheUK.When
anindividualwithestablishedSCIisadmittedto
hospitalforaprocedureorbecauseofillness,
hospitalteamsneedtomanageboththeacute
conditionandthespinalcordinjury.These
guidelinesaimtoassistteamsinassessingand
managingthispotentiallyvulnerablegroupof
peopletoavoidthecommonproblemsof
hospital-acquiredmorbidity. Keystepsare:
anunderstandingofthecommonpatho-
physiologicalconsequencesofSCI
listeningtothepatientandmembersof
theirfamilywhoareoftenexpertin
managingthecondition
maintainingclosecontactwiththe
individual'sregularteam/specialistspinal
cordinjurycentre.
http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/http://www.rcplondon.ac.uk/7/27/2019 Concise Chronic Spinal Cord Injury 2008
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Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 3
Fig 1. Managementofpatientswithautonomicdysreflexia(AD).
Forpatientswithcatheter:
emptylegbagandnotevolume
checktubingnotblocked/kinked
ifcatheterblockedremoveandre-catheterise
usinglubricantcontaininglidocaine
Forpatientswithoutcatheter:
ifbladderdistendedandpatientunable
topassurineinsertcathete rusinglubricant
containinglidocaine
Ifbladderdistensionexcludedgentlyexamineperrectum
Forfaecalmassinrectum:
gentlyinsertglovedfingercoveredinlidocaine jelly intorectumandremovefaecalmass
Ifbloodpressureremainshigh,thenanIVhypotensivemayberequired:
hydrala zine20mgivslowlyor
diazoxide20mgbolus.
Continuetosearchforcauseandmonitorbloodpressure.
Mayrequiremanagementonhighdependencyunitifproblempersists.
Contactaspinalcordinjurycentreforfurtheradvice(seeAppendix4).
Ifsymptomspersistorcauseisunknown
Givenifedipineorglyceryltrintrate(GTN).Inadults,placesublingually:
thecontentsofa10mgsublingualnifedipinecapsuleor 12GTNtablets.Repeatdosecanbegivenafter20minutes,ifsymptomspersist.
cordlesionandarestillcompatiblewitheffective
tissueperfusion.Hypotensionfromothercauses
needstobedistinguishedcarefullyfromthispicture.
Overzealousfluidresuscitationortransfusioncan
causepulmonaryoedemaandincreased
morbidity/mortality.Itishelpfultoascertain
individuals'normalrestingvitalsignsbefore
planningintervention.
IndividualswithSCIatoraboveT6levelareatrisk
ofautonomicdysreflexia(AD) anexcessive
autonomicresponsetostimulibelowthelevelofthe
SCI,suchasablockedcatheterorfaecalimpaction.
Thisisanacuteandlife-threateningconditionwhich
allphysiciansshouldbeawareof.Typicalfeaturesare
showninBox 1(p2),andasuggestedpathwayfor
managementisgivenin Fig1.
Sitthepatientupavoidlyingdown
Checkbloodpressure
Confirmdiagnosis(bloodpressuregreaterthan200/100or2040mmHghigher
thannormal)
SymptomsorsignsofAD
(egpoundingheadache,flushing,sweatingor
blotchingskinaboveinjurylevel;pale,cold,
goosebumpsbelow)
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Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 5
Fig 2. Bladdermanagementinspinalcordinjurypatientswhovoidspontaneousybutfailtoemptytheir
bladdercompletely.UTI=urinarytractinfection.
Spontaneousvoidingbutsuspicionofincompleteemptying,symptomsof:
incontinence
frequentvoidingofurine
UTIs
distendedabdomen/d iscomfort/nausea
autonomicdysreflexia
Totalvoidedvolume
Increased:>2,000 mlDiabete s,diabete sinsipidus,chronicrenalfai lure,drugs,obsessivedrinking
Decreased:500ml)
Small,frequentvolumes(>300ml)
Residualvolume(>50100ml)
ExcludeobstructionConstipation,drugsetc
ExcludeUTI
Consider:DetrusorsphincterdyssynergiaOtheroutflowobstructioneg:
prostatichypertrophy
urethralstricture
bladderstones
Clearuppertracts
Refertospecialisturology/spinalcordinjurycentre
Dilateduppertracts
Specialistinvestigations:
urodynamicstoassesspressures
Otherinvestigationsmayinclude:
transrectalultrasound
urethrogram
11 ConsortiumforSpinal CordMedicine.Preservationofupper
limbfunctionfollowingspinalcordinjury.Aclinicalpractice
guidelineforhealthcareprofessionals.Washington:Paralyzed
Veterans ofAmerica,2005.*
12 ConsortiumforSpinal CordMedicine.Depressionfollowing
SCI.Aclinicalpracticeguidelineforprimarycarephysicians.
Washington:ParalyzedVeterans ofAmerica,1998.*
13 DepartmentofHealth.Dischargefromhospital:pathway,
processandpractice.London:DH,2003.
* Theguidelines canbedownloadedfromthewebsiteof
theParalyzed Veterans ofAmerica
www.pva.org/site/PageServer?pagename=pubs_main
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6 Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings
Fig 3. Bowelmanagementforpatientswithspinalcordinjury.
Maintainregularstoolchart
Avoidconstipatingmedications(egmorphinederivatives,
anticholinergics)asfaraspossible.
Continuepatientsownbowelmanagementroutineunlessproblematic
Interventionsrecognisedasbeneficia linclude:
dietarymanagementbalanceddiet,roleoffluid,fibreandstimulantfoods
regularroutine(regularfood,regularbowelroutinesametimeeachday,samelocationietoilet/bed)
physicalutili singgastrocolicreflexieafterhotdietarytrigger,abdominalmassage,physicalactivi ty
positioningsitontoilet/commodeifpossiblecontinueindividualsusualroutineasfaraspossible
pharmacologicalstoolsofteners,stimulantorosmoticlaxatives
localtriggersfordefaecation(egsuppositories,digitalstimulation,manualevacuation).
Ifstoolsaretoosoft:
iffibreishighormedium:reduceinsolublefibre*
ifthereisnobenefit,reducesolublefibre
iffibreisminimal:graduallyincreaseinsolublefibre.
*Insolublefibreincludes wholegrains,eg wheat,maize,rice.
Avoidfrequentchangesofregimen
Giveeachinterventiontimeto workbeforechanging.
Followingassessment,agreedurationoftrial .
Ifanychangeisrequiredorplanned,
assess: patient sperceptionofbowelcareproblems
onsetofproblemsandrelevantfactors
pastmedicalhistoryandmedication
clinicalexaminationincludingrectalexamination
fluidanddietaryintakeincludingdailyfibreintake
(minimalfibre10g/day,medium18g/day,high25g/day).
Ifstoolsaretoohard:
ensurefluidintake>2L/day
ifinsolublefibreisminimalormedium,graduallyincrease
ifinsolublefibreishigh,tryreducing.
Obstructionexcluded
Consideraddinglaxative,egsenna12nocte,orMovicol,
increasingthisasrequired.
Severeproximalfaecalloading
Mayrequireahighdoseoflaxativestoclear,buttreatment
canbecomplicated.
Contactlocalspinalcordinjurycentreforadvice
(seeAppendix4).
Ifnobowelactionsareoccurringdespitecarefulregimenasabove,aproactiveapproachisneeded:
optimisefluidanddiet
continuelocalevacuationmanagement(suppositories/manualevacuation).
Excludeobstruction:
checkrectumforfaecalloading
pla inabdominalx-rayorultrasoundifnecessarytoexcludebowelobstructionandproximalfaecalloading.
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Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 7
Recommendation Grade
A Staffawarenessandtraining
1 Thepossibilityofthefollowingcomplicationsshouldbeconsideredinanypatientwith C
establishedspinalcordinjury(SCI)admittedtohospital:
respiratoryproblems includingrespiratoryfail ureandinfection
autonomicdysreflexia inlesionsatoraboveT6
deepveinthrombosis(DVT)
pressuresores
inadequatenutrition
neurologicaldeterioration
bowelproblemsincludingconstipationandincontinence
bladderproblemsincludingurinaryretention,infectionandcalculi
musculoskeletalproblemsincludingpain,injuryandcontractures
depression,anxietyandothermooddisturbance.
2 Specificstafftraining
Inparticular,allnursingandmedicalstaffshouldhavespecifictrainingintherecognition C
ofsymptomsandmanagementof:
secondarymusculoskelet alpain,injuryandcontractureincludingpreventionandmanagementofspasticity
autonomicdysreflexia(AD)
bladdermanagementtechniquesincluding
cleanintermitt ent
catheteri
s
ation bowelmanagementtechniques
appropriateuseofsuppositories,enemasandlaxatives
digitalstimulationandmanualevacuation
Staffshould beawarethatsome patientsare dependentonmanualevacuationfortheir bowelcare.
Failuretoprovidethismay resultinconstipationand riskofseriouscomplications,including bowel
obstructionandautonomic dysreflexia.
emotionaldisturbance.
THEGUIDELINES
Continuedoverleaf
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8 Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings
Recommendation Grade
B AssessmentofpatientswithSCI
1 Initialassessmentofallpatientsonadmissionshouldincludethefollowing: C
respiratoryassessment:fullhistoryandexaminationincludingbaseline:
pulse,respiratoryrate,andtemperature
oximetry
vitalcapacity(VC)andforcedexpiratoryvolume(FEV)1(ifpossible)
forperioperativepatients,orotherincreasedriskofchestpathology:
arteria lbloodgasesandchestx-rays
skinandpressureulcerriskassessment:
withgradingofanyexistingulcers
baselinecalfandthighmeasurementstoall ow earlydet ectionofDVT
urinaryassessmentincluding:
review ofvoidingmethodandpatt ern
24-hourvoidedvolumechart
post-voidresidualvolume(bycatheterorbladderscan),ifvoidingonurgeorbyreflex
urinarymicroscopyandculture,ifsymptomsorsignsoflocalorsystemicinfection
assessmentofbowelcareneeds:
planofmanagementdeveloped within24hoursofadmission
nutritionalassessmentincluding:
dietaryintake
weightandbiochemistry(album in,haemoglobin,haematinics).
fullneurologicalassessmentassoonaspossibletoidentifypatient'sbaseline,therebyensuringearly
detectionofanydeterioration
musculoskeletalassessmentincludingspasticityassessment,assessmentof jointrangeofmovementandpain.
psychiatrichistoryincludingscreeningfordepression.Useofatleasttwoquestions:
'Duringthelastmonth,haveyouoftenbeenbotheredbyfee lingdown,depressedorhopeless?'
'Duringthelastmonth,haveyouoftenbeenbotheredbyhavingli tt leinterestorpleasureindoingthings?'
2 Regularassessmentsthereaftershouldincludethefollowing: C
dailyassessmentof:
calfandthighmeasurementstoal low earlydet ectionofDVT
skinandpressureareas
frequentassessment,asappropriate,of:
respiratoryfunctionincluding:
symptomcheckandexamination
pulse,respiratoryrate,temperature
oximetry,VCandFEV1(ifunstableoratrisk)
bowelfunction,including:
stoolconsistency
frequencyofbowelactionandinterventions
neurologicalimpairments,ifthereisconcernthatthisischanging.
THEGUIDELINES
Continuedoverleaf
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Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 9
Recommendation Grade
C ManagementofpatientswithSCI
1 AllpatientswithSCIadmittedtohospitalshould: C
bediscussed(followingtheirconsent) withtheirspinalcordinjurycentreforinformationandadviceas
indicated(seeAppendix4fordet ail sofcentres)
havea writtencareplan whichincludes:
managementofautonomicdysreflexiaforpatientsatrisk(T56orabove)seeFig1(p3).
respiratorymanagementtopreventortreatchestcomplications,developedinconjunction witha
chestorneurophysiotherapist.Thismayinclude:
clearingofairwaysecret ions:assistedcoughing,suctioning(beawareoftheriskofbradycardia
inducedbysuction)
re-expansionofaffectedlungincludingdeepbreathing,positioning,IPPV, BiPAP,bronchoscopy with
lavageandmedications
commencingthromboembolicprophylaxisifimmobil ised withbedrestoradmitt edformedicalil lnessor
surgery(asperhospitalpolicy)including:
thromboembolismdeterrent(TED)stockingsunlesscontraindicated
low molecular weightheparin*
preventativemeasurestoavoidpressuresores,orfullpressurereliefinthepresenceofexistingulcers
adequatenutritionprovidedtomeetindividualneedsincludingcalories,prote in,micronutrientsandfluids.
aggressivenutritionalsupportif:
diet aryintakeisinadequate,ortheindividualisnutritionallycompromised
continuationofnormalbowelmanagementprogramme,unlessthereisreasontochange,including
diet,useoflaxativesandbowelstimulants
digitalstimulationandmanualevacuationasrequired
continuationofnormalbladdermanagementprogramme,unlessthereisreasontochange.Ifan
indwell ingurethralcatheterhasbeennecessaryduringtheadmissionitshouldberemovedassoonasis
possibleandthepatient'susualbladdercareregimenre-established
managementofspasticityandavoidanceofsecondarymusculoskeletalcomplicationsincluding:
splinting,stretchingandpassivemovement,ifappropriate
regularstandingprogramme,ifappropriate .
2 AllpatientswithSCIadmittedtohospitalshouldhaveappropriatedischargeplanninginvolving: C
thepatientandtheirfamily
relevantmembersofthemultidisciplinaryteam
directcontact withthecommunitycareteam(egGP,districtnurse,communityrehabili tation
profess
ionals)b
efor
edi
schar
ge.
Thefollowingshouldbeinplacebeforedischarge:
all requiredarrangementsfortransport,careandequipmentneedsetc
fullreportsfromall professionalsinvolved withtheircare
appropriatetransportarrangementsmadeforanyfutureoutpatientorreview appointments.
IPPV=intermittentpositivepressure ventilation;BiPAP=bi-phasicpositiveairwaypressure.
*Patients withestablishedSCIdonotrequire long-termthromboprophylaxis unless thereis ahistoryofthromboembolicdisease.Thereforenormal prophylaxis shouldbe givenfortheillness/procedure,according to local policyandcanbe stoppedas usual whenthepatientismedically well.
THEGUIDELINES
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10 Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings
Scopeandpurpose
Overall objectiveof Tohighlighttheimportantaspectsintheassessmentandmanagementofindividuals withchronic.
theguidelines spinalcordinjury(SCI).
Thepatientgroup Adults withestablishedSCI whopresentinanacutehospitalsetting witharelatedorcovered unrelatedcondition.TheseguidelinesdonotaddressthemanagementofacuteSCI.
Targetaudience Generalphysiciansandothercliniciansinvolvedinthemanagementofadults withSCI whenthey
areadmittedtoanacutehospitalsetting.
Clinicalareascovered Generalassessmentofadults withSCI whenadmittedtohospital withrelatedorunrelated
condition.Generalmanagementprinciplesforadults withSCI whenadmitt edtohospital with
relatedorunrelatedcondition.
Stakeholderinvolvement
TheGuideline Amultidisciplinarygrouprepresenting:physiciansandsurgeonspractisinginspinalcordinjury
DevelopmentGroup management,physiotherapy,occupationaltherapy,nursing,psychologyandusers.
Funding Funding waskindlyprovidedbythe BritishSocietyofRehabil itationMedicine.
Conflictsofinterest Nonedeclared
Rigourofdevelopment
Evidencegathering Evidenceforthisguideline wasprovidedbyreview ofCochraneLibrary,Medline,Embaseandother
guidelinesuptoSeptember2006.
Review process Theevidence wasevaluatedbymembersoftheGDG.
Linkbetweenevidence Thesystemusedtogradeevidenceandguidancerecommendationsisadaptedfromthatpublished
andrecommendations bytheRoyalCollegeofPhysicians(seeAppendix2).
Pilotingandpeerreview Notyetpilotedal thoughithasbeenreviewedbystakeholdergroups.
Implementation
Toolsforapplication Thisguideline will bemadeavailabletohospitalcliniciansthroughthePublicationsDepartmentof
theRoyalCollegeofPhysiciansand will appearonthe websitesofthe BritishSocietyof
Rehabili tationMedicine(www.bsrm.co.uk),theMultidisciplinaryAssociationofSpinalCordInjury
Professionals(www.mascip.co.uk),the BritishAssociationofSpinalCordInjurySpecialists
(www.bascis.pwp.blueyonder.co.uk)andtheSpinalInjuriesAssociation(www.spinal .co.uk).
Plansforupdate Theguidelines wil lbereviewedin2012.
Appendix1.Guidelinedevelopmentprocess
http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.bsrm.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.mascip.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.spinal.co.uk/http://www.bascis.pwp.blueyonder.co.uk/http://www.mascip.co.uk/http://www.bsrm.co.uk/7/27/2019 Concise Chronic Spinal Cord Injury 2008
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Chronicspinalcordinjury:managementofpatientsinacutehospitalsettings 11
Appendix2.Levels ofevidence
Level Typeofevidence Gradeofrecommendation
IA Meta-analysisofrandomisedclinicaltria lsorinceptioncohortstudies A
IB Atleast1randomisedclinicaltrial or welldesignedcohortstudy withgoodfollow-up A
IIA Atleast1 welldesignedcontrolledstudy withoutrandomisationoramet a-analysisofcasecontrolstudies BIIB Atleastonestudy withquasiexperimentaldesignorcase-controlstudy B
III Atleast1non-experimentalstudy(egdescriptivestudy) C
IV Expertcommitteereportsorreportsbyrecognisedauthorities C
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12 Chronicspinalcordinjury:managementofpatientsinacutehospitalset tings
No Yes Date Signature
Careplanforautonomicdysreflexia
Respiratoryassessmentandmanagementplan
Thromboembolicprophylaxis:
thromboembolicdeterrentstockings
low molecular weightheparin
Skinassessmentandpressuresorepreventionstrategyinplace
Nutritionalassessmentandmanagementplan
Bowelassessmentandmanagementplan
Bladderassessmentandmanagementplan
Neurologicalassessment
Musculoskeletalassessmentandmanagementplan
Depressionscreeningquestionsandfollow-upasrequired
Dischargeplanning:
carearrangementsfordischarge
GPandcommunitynursinginformed
dischargereports
Appendix3.Checklistforassessmentandmanagementofindividuals
withestablished spinalcordinjury
Telephoneadviceisavailablefromspinalcordinjurycentres.Localspecialistneurorehabil itationteamscanalso
oftenofferusefulpracticalsupport'ontheground'.
7/27/2019 Concise Chronic Spinal Cord Injury 2008
15/15
Chronicspinalcordinjury:managementofpatientsinacutehospitalset tings 13
Appendix4.Spinalcordinjurycentres (SCICs)
Area Unit Telephone
England
Middlesbrough GoldenJubileeRegionalSCIC 01642282641
Oswestry MidlandSCIC 01691404000
Pinderfields YorkshireRegionalSCIC 01924212358
Sal isbury DukeofYorkSpinalTreatmentCentre 01722336262
Sheff ield PrincessRoyalSpinalInjuriesUnit 01142715609
Southport SouthportRegionalSpinalInjuriesUnit 01704704345
Stanmore LondonSCIC(RoyalNational OrthopaedicHospital) 02089095583/8
StokeMandeville TheNationalSpinalInjuriesCentre 01296315000
NorthernIreland
Belfast SCICMusgraveParkHospital 02890902000
Scotland
Glasgow The QueenElizabethSpinalInjuriesCentre 01412012530
Wales
Cardiff RookwoodSpinalInjuriesRehabil itationCentre 02920415415
