# Indications to Consult Physiatry (PMR)

#### Purpose

To identify criteria for early physiatry (PMR) consultation and expertise on the multidisciplinary trauma care team following admission.

#### PMR Consult Service

The PMR consult service is ran by Dr. Dan Pierce. He is available to see consults on patients admitted to the trauma service on Monday, Wednesday, and Fridays and provide additional expertise the management and care of various injury as treatment moves from the acute phase to the recovery and rehabilitation phase.

#### Indications for Consult

**<span style="font-family: 'Arial',sans-serif;">1.<span style="mso-spacerun: yes;"> </span>Spinal cord injury </span>**<span style="font-family: 'Arial',sans-serif;">(timing: ideally as soon after admission as possible)</span>

- <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">All acute spinal cord injured patients (cervical/thoracic/lumbosacral and conus medullaris/cauda equina), including pediatrics</span>
    - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Perform ISNCSCI (ASIA Impairment Scale) exam</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Management of physiatry-related complications following trauma</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Neurogenic bowel/bladder</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Orthostatic Hypotension/Autonomic Dysreflexia</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Concomitant brain injury care</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Spasticity management/contracture prevention</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Pulmonary/vent weaning</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Prevention of skin breakdown</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Pain</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Assist in transition to post-acute care</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including insurance denials/peer-to-peer</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Coordinate rehabilitation care (PT/OT/ST) prior to discharge</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Patient/family education</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including presence at family meetings and prognosis discussions</span>
- <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">All chronic spinal cord injured patients if they have a new injury and are admitted to trauma service</span>

**<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt 'Times New Roman';"> </span></span></span>****<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Traumatic Brain Injury </span>**<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">(timing: ideally as soon after admission as possible)</span>

- <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Courier New'; mso-fareast-font-family: 'Courier New';"><span style="mso-list: Ignore;"><span style="font: 7.0pt 'Times New Roman';"> </span></span></span><span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Severe and moderate brain injuries, including pediatrics</span>
    - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Management of physiatry-related complications following trauma</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Arousal</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Agitation secondary to post-traumatic amnesia</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Paroxysmal Sympathetic Hyperactivity (“neurostorming”)</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Neurogenic bowel/bladder</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Spasticity management/contracture prevention</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Prevention of skin breakdown</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Pain</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Assist in transition to post-acute care</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including insurance denials/peer-to-peer</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Coordinate rehabilitation care (PT/OT/ST) prior to discharge</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-bidi-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt 'Times New Roman';"> </span></span></span><span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Patient/family education</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including presence at family meetings and prognosis discussions</span>

**<span style="font-family: 'Arial',sans-serif; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt 'Times New Roman';"> </span></span></span>****<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Traumatic limb loss</span>**<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;"> (timing: ideally as soon after admission as possible)</span>

- <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;"><span style="font: 7.0pt 'Times New Roman';"> </span></span></span><span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Upper and Lower extremity, including pediatrics</span>
    - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Management of physiatry-related complications following trauma</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Contracture prevention</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Pain</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Assist in transition to post-acute care</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including insurance denials/peer-to-peer</span>
                - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">coordinate rehabilitation care (PT/OT/P&amp;O) prior to discharge</span>
        - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Patient/family education</span>
            - - <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Including presence at family meetings and prognosis discussions</span>

<span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">Consultations for the following injuries may also be considered and will be seen on an as needed basis during the patient's hospital admission: </span>

1. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">multiple musculoskeletal trauma</span>
2. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">traumatic peripheral nerve injuries, including crush </span>
3. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">pediatric traumas </span>
4. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">mild-moderate brain injury</span>
5. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">burns</span>
6. <span style="font-size: 10.0pt; line-height: 107%; font-family: 'Arial',sans-serif;">other injuries requiring post-acute rehabilitation </span>

##### Author(s)

Dan Pierce, MD, Department of Physical Medicine and Rehabilitation

##### Last Updated

June, 2023