An update on spinal cord injuries in October 2005 earthquake in Pakistan

Rathore, Farooq Azam; Farooq, Fareeha; Butt, Aamir Waheed; Gill, Zaheer Ahmed

doi:10.1038/sj.sc.3102162

Cited by 17 publications

(18 citation statements)

References 4 publications

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“…In under-developed countries, cost of instrumentation is tremendous, compared to per capita income, infection rates are high, rehabilitation centers are few, and follow up is poor. [27293032] The mean cost incurred for surgical stabilization at our center was USD 6500, which is enormous in the background of USD 846 per capita GDP of our country. Such expenditure appears unjustified for a procedure which does not have evidence proven advantage in any way.…”

Section: Discussionmentioning

confidence: 99%

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

Shamim

Ali²,

Enam³

2011

Surg Neurol Int

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Background:Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view.Methods:A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up.Results:Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001).Conclusion:We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

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Section: Discussionmentioning

confidence: 99%

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

Shamim

Ali²,

Enam³

2011

Surg Neurol Int

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“…Seven of these papers were excluded either due to lack of epidemiological data on SCI 6,7 or because they cited earlier publications. [8][9][10][11][12] The remaining eight studies [13][14][15][16][17][18][19][20] were analyzed. Three additional papers on SCI following the EQs in China and Haiti [21][22][23] written by the authors (JR, JG) and another paper by Burns 24 were identified by manual search.…”

Section: Methodsmentioning

confidence: 99%

“…9 Community-based rehabilitation initiatives in post-EQ Pakistan were limited, sometimes resulting in medically dischargeable patients remaining in hospitals because of lack of care alternatives in the community. 11 The international humanitarian medical rehabilitation response to the 2005 Kashmir EQ mainly consisted of rehabilitative post-surgical care provided by foreign medical teams. Teams from the Swiss Paraplegic Centre and Handicap International, an international rehabilitation services non-governmental organization (NGO), provided SCIspecific services as well at AFIRM and the National Institute of Rehabilitation Medicine SCI Center.…”

Section: Selected Data From Recent Severe Eqsmentioning

confidence: 99%

Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research

et al. 2013

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Study design: Narrative literature review. Objectives: To (1) summarize epidemiological and scientific research on spinal cord injury (SCI) populations from three severe earthquakes (EQs) in rehabilitation resource-scarce settings; (2) summarize SCI rehabilitation services by local and foreign providers in response to these EQs and (3) provide implications including research gaps for a supporting global scientific research agenda. Setting: International. Methods: A literature review was conducted using PubMed to identify epidemiological studies reporting data on SCI survivors of the 2005 Kashmir EQ in Pakistan, the Sichuan EQ of 2008 in China and the 2010 Haiti EQ. A follow-up review on the SCI rehabilitation services provided by local and foreign providers in response to these EQs was also performed. Results: Review of the scientific literature revealed the qualitative trends in focused EQ victim epidemiological data, including SCI classification and types of medical complications. Selected EQ country narratives showed that post-disaster SCI rehabilitation services were expanded by adapting local resources with international assistance to manage the significant numbers of SCI survivors. The resulting SCI research was limited. Conclusion: A global disaster research agenda for SCI in EQs in rehabilitation resource-scarce settings is needed to strengthen the evidence base for improvement of clinical management and outcomes for SCI EQ survivors. Expansion of this limited narrative review into a systematic review to identify additional research gaps is a proposed next step. Effective disaster setting data management and research collaborations of foreign and local SCI disability and rehabilitation stakeholders will be required for agenda implementation.

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“…Co-ordination difficulties in the response phase were frequently reported both within and between healthcare services 41,43,55,103,107,110 . These difficulties were exacerbated by poor information and intelligence management 35,51,103 .…”

Section: Coordination Response and Logisticsmentioning

confidence: 99%

“…The medical capacity and expertise to manage such cases was however, often limited and positive outcomes were not assured 3 with one study reporting mortality as the most likely outcome for quadraplegics 43 . Countries had to develop rehabilitation services 39,[44][45][46][47] to deliver rehabilitation over the long term 3,43,47 .…”

Section: Thematic Analysismentioning

confidence: 99%

The changing health priorities of earthquake response and implications for preparedness: a scoping review

2017

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An update on spinal cord injuries in October 2005 earthquake in Pakistan

Cited by 17 publications

References 4 publications

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research

The changing health priorities of earthquake response and implications for preparedness: a scoping review

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