Challenges in comprehensive management of spinal cord injury in India and in the Asian Spinal Cord network region: findings of a survey of experts, patients and consumers

Chhabra, Harvinder Singh; Sharma, Seema; Arora, Mohit

doi:10.1038/sc.2017.102

Cited by 18 publications

(14 citation statements)

References 26 publications

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“…Outof-pocket healthcare expenditure in a poverty-ridden society like Nigeria may endanger the entire population. Moreover, SCI patients and their families are at risk of poverty and in dire need of inancial assistance [9]. Another important risk factor for UTI observed in this study is the practice of entrusting the purchase of consumables and medical supplies in the hands of patients' relations.…”

Section: Discussionmentioning

confidence: 80%

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Adefolarin¹,

Aminu²,

Augustine³

et al. 2019

J Clini Nephrol

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Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identifi ed include fi nancial problems, organization of care, human error, hospital environment and patientrelated factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered.

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Section: Discussionmentioning

confidence: 80%

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Adefolarin¹,

Aminu²,

Augustine³

et al. 2019

J Clini Nephrol

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“…However, these facilities are often inaccessible and unaffordable for many patients. A recent study reported that nearly 63% of Indian patients with SCI reached a definitive centre after two to three institutional transfers and 22% of the patients reached a definitive centre more than a month after the injury [16]. The magic window of 24 h is often lost when trying to get the patient to an equipped centre for surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Delayed Surgical Interventions (> 72 h After Injury) in Patients with Incomplete Spinal Cord Injury: Observations from a Tertiary Rehabilitation Centre in India

Sahoo¹,

Sreeja²,

Das³

et al. 2020

SN Compr. Clin. Med.

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There is no consensus on the timing for early surgery in spinal cord injury (SCI). On Pubmed, we found no primary research article from India evaluating the effects of timing of surgery on outcomes in SCI patients. This single-centre prospective observational study was done to evaluate the outcome of surgical decompression done > 72 h after traumatic incomplete SCI and assess prognosis over 6 and 12 months. Patients, with history of traumatic incomplete SCI of < 6-month duration and below C5 vertebra level, who had had late surgery (> 72 h after the injury) elsewhere were enrolled. A complete and standard neurological examination was done at presentation. Neurological and functional recovery was assessed at 6 and 12 months. Forty-two patients fulfilling the inclusion criteria were followed up of at least 12 months. At baseline, 31 had ASIA B and 11 had ASIA C grade. By 6 months, 4 patients improved by 1 ASIA grade. By 12 months, 14 patients improved by 1 grade and two by 2 grades. Mean motor recovery and overall functional recovery were significant (p = 0.03 and p < 0.001 respectively). Patients with lumbar injuries had significantly better overall functional recovery at both 6 (p = 0.006) and 12 months (p < 0.001). ASIA C group recovered significantly better than ASIA B group in terms of mean motor recovery percentage (14.33 vs 8.12, p = 0.014 at 6 months; 23.96 vs 16.56, p = 0.016 at 12 months) and mean spinal cord independent measures (SCIM) recovery percentage (43.01 vs 32.03, p = 0.039 at 6 months; 62.25 vs 38.4, p < 0.001 at 12 months). Surgery > 72 h after incomplete traumatic SCI, assessed at 2-4 months post injury, may still have encouraging outcomes. Our study may be the first from India to assess the outcome of delayed surgery in incomplete SCI patients but larger prospective studies involving multiple centres are needed for stronger evidence. Inclusion of non-operative cohort would have differentiated the result from spontaneous recovery.

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“…This case was managed in a center recognised by the government as the Apex Tertiary Level Center for management of spinal injuries. However, the same facilities and expertise is not available in most other centers in the country [20], and thus most of the centers would not have been able to manage such a patient with the same kind of positive outcome. India does not have appropriate public health resources with only 3.93% of the GDP spent on health expenditure [21].…”

Section: Indian Scenariomentioning

confidence: 99%

“…However, 66% of the population still lives in rural areas [22], where health needs are mainly taken care by the public hospitals (primary health centers), which have only basic amenities and such patients could not have been appropriately managed. In fact, most of such centers would not have the multi-disciplinary team required for the management of such patients [20].…”

Section: Indian Scenariomentioning

confidence: 99%

Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review

Pedaballe

Chhabra

Tandon

et al. 2018

Spinal Cord Ser Cases

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Background: The management of acute traumatic cervical spine injury in a third-trimester pregnancy is challenging with risks involved for both the mother and the fetus. We report one such case that was managed successfully with good maternal and fetal outcomes. Case presentation: A 30 years female, gravida 2, para 1, living 1 at 31 weeks 5 days of pregnancy, met with a RTA and was diagnosed with AIS B C4-C5 extension compression spinal cord injury (SCI) with a viable fetus. Closed reduction of C4-C5 dislocation was achieved through controlled cervical traction. Having involved the patient in informed decision-making, anterior cervical discectomy and fusion (ACDF) was performed under general anesthesia (GA), with obstetrician, as well as neonatologist available in the operation theater. The pregnancy was uneventful in the post-operative stage. A healthy baby was delivered at 36 weeks of gestation through cesarean section. At final follow-up review of 12 months the patient was ambulatory without support and was able to perform most of the regular activities independently. Discussion: The significant risk of a spontaneous delivery with GA posed the dilemma of either managing the injury conservatively through bed rest, continuing the pregnancy till its term and then opting for surgical stabilization after delivery or opting for surgical stabilization of the spine immediately, with a view for early mobilization and rehabilitation. A successful outcome of traumatic cervical SCI in third-trimester pregnancy can be achieved by multidisciplinary (anesthetist, obstetrician, neonatologist, spine surgeon, and physiatrist) team, and timely surgical spinal stabilization, followed by early comprehensive rehabilitation.

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Challenges in comprehensive management of spinal cord injury in India and in the Asian Spinal Cord network region: findings of a survey of experts, patients and consumers

Abstract: Our study brought out that SCI in India and ASCoN region face numerous challenges that affect access to almost all aspects of comprehensive management of SCI.

Cited by 18 publications

References 26 publications

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Perceived causes and prevention of catheter-associated urinary tract infections among spinal cord injured patients

Outcomes of Delayed Surgical Interventions (> 72 h After Injury) in Patients with Incomplete Spinal Cord Injury: Observations from a Tertiary Rehabilitation Centre in India

Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review

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