Emergency Department and PICU Clinical Pathway for Evaluation/Treatment of Children with Suspected Traumatic Spinal Cord Injury

Goals and Metrics
Patient Education
Provider Resources
Traumatic Spinal Cord
Injury Suspected
Initial Assessment
and Resuscitation
  • Goals
  • Avoid hypotension
  • Avoid hypoxia - Titrate supplemental O2 for SpO2 > 92 and < 98%
  • Maintain normothermia
  • Maintain safety
  • Adequate analgesia
  • Trauma Team Resuscitation
  • ATLS protocol
  • Spinal immobilization including cervical collar
  • Spinal Trauma Consult
Plain Radiograph,
+/- Dedicated CT
Admission to PICU
Ongoing Resuscitation
24 - 48 hours
  • Goals
  • Avoid hypotension
  • Avoid hypoxia - Titrate supplemental O2 for SpO2 > 92 and < 98%
  • Prevent secondary neurological injury
  • External/internal stabilization of spine, as indicated
  • Tertiary exam per ATLS Standard - Treat additional injuries
Stabilization
  • Stabilization Complications
  • Spinal shock
  • Orthostatic hypotension
  • Respiratory insufficiency
  • Feeding Intolerance
  • Temperature instability
48 hours and on
  • Goals
  • External/internal stabilization of spine, as indicated (if not previously completed)
  • ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury) exam
  • Initiate/advance nutrition
  • Neurogenic bowel and bladder care
  • Adequate analgesia
  • Rehabilitation consults/advance in activity
  • Prevent/treat SCI related complications
Recovery
  • Recovery Complications
  • Autonomic dysreflexia
  • Respiratory insufficiency
  • Neuropathic pain
  • Superior mesenteric artery syndrome
  • Hypercalcemia
  • Joint contracture
  • UTI/urosepsis
  • Vesicoureteral reflux
  • Muscle spasticity
  • Scoliosis
  • Osteopenia
  • Decubitus ulcer
  • Goals
  • Patient/family education and training
  • Discharge Planning
Discharge to Rehabilitation Facility
  • Discharge Criteria
  • Hemodynamically stable
  • Taking adequate calories enterally (PO and/or feeding tube)
  • Definitive airway with stable respiratory exam
  • Spine stabilized
  • Pain managed with enteral or topical medications
  • Bowel and Bladder Program initiated
  • Skin care regimen in place
  • Tolerating increased activity/rehabilitative services
  • Other injuries addressed/treatment plan in place
  • Family/patient knowledgeable about patient care and indications for inpatient rehabilitation
Resources Contact Info:
  • Trauma Fellow: 10258
  • On-call Trauma Nurse Practitioner:
    See staff directory
  • On-call Neurosurgery: 10781
  • On-call Orthopedics: 11014
  • Pain Management: 10444
  • Wound Care APN: 16787
  • Boston Orthotics & Prosthetics (O&P): 215-634-9399
  • Specialty Bed: Unit-based CNS or
    Nursing Supervisor (off shifts)
  • PM&R: 76303
Posted: August 2015
Revised: January 2017, January 2018, August 2018, March 2020, August 2020
Authors: J. Osipowicz, CRNP; M. Nance, MD; A. Weiss, MD