Note: This guideline is currently under review. Show
IntroductionSpinal cord injury (SCI) in children is a rare injury that can result in permanent loss of motor and sensory function, and dysfunction of the bowel and bladder. Impairment of these functions result in significant social and psychological consequences for the child and their family. SCI is often associated with a traumatic brain injury. In children and adolescents SCI is most commonly a result of road traffic accidents, falls or diving into water. Children with SCI experience multiple health care problems including autonomic instability, complications of immobility and bowel or bladder dysfunction. Management in the acute phase is aimed at preventing further spinal cord injury, maintaining physiological stability, and commencing routine care of the skin and establishing good bladder and bowel care. AimThis guideline is aimed at the acute management of children with injury to the spinal cord. Definition of terms
SCI pathophysiology & presentationComplete/incomplete injury
Cause of injury
Pathophysiology
Signs & symptoms of acute SCI
ManagementInitial assessmentSee major trauma-primary survey guideline (link) and cervical spine injury guideline (link) for initial assessment
Referrals
Admission location
Spinal immobilisationSee cervical spine injury guideline (link)
Imaging
Neurological assessment
Vital signs (and autonomic control)
Heart rate
Blood pressure
Temperature
Breathing
SkinSee Pressure injury prevention guideline (link) A patient who has a SCI is at high risk of damage to their skin integrity. The SCI causes loss of sensation of pain, pressure & temperature. The patient may also have lost motor control and have poor autonomic nervous system function. The end result is a lack of sensory warning mechanisms, an inability to move and circulatory changes all impacting on skin integrity.
BladderUrinary bladder function may be affected by SCI. The muscles and sphincters of the bladder are normally controlled by neurological input and spinal reflexes. Loss of this normal neurological control of the bladder is commonly referred to as a neurogenic bladder. The aim of bladder care is to prevent infections, minimise and contain incontinence and find an appropriate way to empty the bladder. This will need to be related to the child’s developmental level, lifestyle, and family needs. For the adolescent patient sexual function also needs to be considered.
BowelsBowel function will be affected by loss of neurological control of its function (neurogenic bowel). In addition, medications such as antibiotics and opioids, immobility, alterations is food, fibre and fluid intake may affect function. Patients are at risk of constipation, impaction and diarrhoea. It is important to
achieve regular bowel emptying. Constipation is not only troublesome but can also trigger major complications such as autonomic hyper-reflexia (dysreflexia).
Nutrition
Thromboprophylaxis
Postural hypotensionPatients with SCI are at risk for postural hypotension when moving from supine to sitting upright. This is due to loss of sympathetic autonomic nervous system innervation and include an inability to regulate BP normally with vasoconstriction. Do not attempt to start sitting patient up until medical approval given.
Joint contracturesAbnormal muscle tone and lack of movement can result in joint contractures. Referrals should be made to Physiotherapy, Occupational Therapy and Orthotics within 1-2 days of admission:
Autonomic hyperreflexia (Dysreflexia)
Sexual function
Psychological
Make appropriate referrals:
Potential complications and managementThe following are the most common complications seen for these children. The prevention and management is described above under the relevant headings
Family centred care
Special considerations
Companion documents
Links
References
Evidence tableSpinal Cord Injury (Acute Management) evidence table Please remember to read the disclaimer The development of this nursing guideline was coordinated by Janine Evans, Rosella - PICU, and approved by the Nursing Clinical Effectiveness Committee. Updated April 2015. Which nursing actions are appropriate during the primary survey of the emergency assessment process?Nursing actions that are appropriate during the primary survey include immobilizing the cervical spine, preparing for chest tube insertion, and applying direct pressure to a wound.
Which nursing skill is essential for the triage process in the emergency department ED )?Abstract. Triage decision making is an essential skill for nurses. Through initial assessment, a nurse must be able to prioritize patient care on the basis of appropriate decision making.
Which actions are included in the secondary assessment for a patient who has possible traumatic injuries?The secondary survey is performed once the patient has been resuscitated and stabilised. It involves a more thorough head-to-toe examination, and the aim is to detect other significant but not immediately life-threatening injuries.
What's the priority intervention when assessing a client with multisystem trauma?Immediate priority is given to airway control and to maintenance of ventilation, oxygenation, and perfusion. Cervical spine protection is crucial during airway assessment and manipulation. When several personnel are involved, a trauma team leader is important to coordinate management in the multiply injured patient.
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