Spinal Cord Injury, SCI, Traumatic — Traumatic Spinal Cord Injury Suspected — Clinical Pathway: Emergency and Inpatient

Spinal Cord Injury (SCI) Clinical Pathway — Emergency Department and ICU

Traumatic Spinal Cord Injury Suspected

This pathway should guide the care of:

Patients with a suspected or confirmed traumatic spinal cord injury who do not meet the exclusion criteria listed below.

Exclusion Criteria:

  • Spinal cord injury secondary to underlying congenital condition
  • Spinal cord injury secondary to acquired medical or surgical condition

The following patients are considered to be at special risk for spinal trauma:

  • Patients with suspected abusive head trauma.
  • Polytrauma patients.
  • Inadequately restrained occupants involved in a motor vehicle crash.
  • Occupants in a motor vehicle crash who are ejected from the motor vehicle.
  • Drivers or riders of recreational vehicles such as motorcycles and ATVs.
  • Patients who are unconscious following trauma.
  • Patients with head and torso injuries.
  • Note: Patients presenting intoxicated or with otherwise altered sensorium need to be carefully evaluated as the exam may be altered.

Signs and symptoms associated with spinal cord injury include:

  • Focal or generalized motor and/or sensory deficits
  • Autonomic dysfunction
  • Loss of deep tendon reflexes or rectal sphincter tone
  • Evidence of encroachment into the spinal canal by bone, foreign body, etc.
  • History of transient neurologic deficit, e.g., numbness or weakness
  • Neck pain/trauma with fluctuating neurologic exam suggestive of arterial dissection