Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

Abstract

Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.

Surgical management of traumatic spinal injuries in Sylvanus Olympio Teaching Hospital

“…At presentation, 31.2% of patients in our series had complete de cit (ASIA A). This nding is under the rates reported in Nigeria, 91.9% and 52.6 %, respectively, by Obalum et al ( 4) and Yusuf et al (13). Our ASIA A rate is higher than 22.1% of ASIA A at the admission foud by Sane et al (17).…”

Perfil epidemiológico do traumatismo raquimedular em um hospital de referência do Distrito Federal: um estudo retrospectivo

“…Lesões secundárias na medula espinhal ou complicações do trauma são mais bem prevenidas ou minimizadas por um atendimento pré-hospitalar adequado, tratamento especializado de forma rápida e eficiente e reabilitação abrangente. Acesso antecipado aos especialistas em trauma raquimedular 24 horas após o trauma, com admissão em unidades especializadas em tratamento da lesão da medula espinhal, mostraram menos complicações durante a internação, como também um menor tempo de reabilitação pós-alta (YUSUF et al, 2019).…”

Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

“…Traumatic spinal cord injury (SCI) is a leading cause of morbidity and mortality 1 and cervical spine is the commonest anatomical level of injury. [2][3][4] The impact of SCI on society and resources is huge both in the acute and rehabilitation settings. 2,3,5 With the limited resource setting in underdeveloped countries like Nepal, questions are often raised whether the outcome of this group of patients justifies the expenses of their care.…”

“…2,3,5 With the limited resource setting in underdeveloped countries like Nepal, questions are often raised whether the outcome of this group of patients justifies the expenses of their care. 1,[3][4][5] Few studies describe the outcome of cervical SCI patients admitted to the intensive care unit (ICU) in underdeveloped countries with limited ICU services. 1,[5][6][7][8] The major challenge toward optimal care of cervical SCI patients in our setting is near absence of health insurance coverage.…”

“…1,[5][6][7][8] The major challenge toward optimal care of cervical SCI patients in our setting is near absence of health insurance coverage. 3,9 This necessitates out of pocket payment for healthcare which puts a huge financial burden on the population with minimal per capita income especially with one quarter population below poverty line. 9 There is scant epidemiological literature for patients with cervical SCI in Nepal.…”