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

Abstract

Study Design: Retrospective study. Objectives: Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). Methods: All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. Results: Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. Conclusions: Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.

Separation from mechanical ventilation and survival after spinal cord injury: a systematic review and meta-analysis

“…Six studies were multicentric [ 30 – 35 ], 33 were conducted at a single site [ 8 , 12 , 36 – 66 ]. Most studies were conducted either in Level I [ 8 , 37 , 42 , 46 , 57 , 61 , 63 , 66 ] or in unspecified trauma/SCI treatment centers [ 12 , 31 , 35 , 36 , 38 , 39 , 41 , 43 , 47 , 48 , 50 – 52 , 55 , 59 , 62 , 65 ]. Twenty-five studies were run in ICUs [ 12 , 30 – 33 , 35 – 44 , 46 , 57 , 59 – 62 , 64 – 66 ], 14 in rehabilitative settings [ 34 , 45 , 47 – 56 , 58 , 61 ] (Additional file 1 : Table S1).…”

“…Most studies were conducted either in Level I [ 8 , 37 , 42 , 46 , 57 , 61 , 63 , 66 ] or in unspecified trauma/SCI treatment centers [ 12 , 31 , 35 , 36 , 38 , 39 , 41 , 43 , 47 , 48 , 50 – 52 , 55 , 59 , 62 , 65 ]. Twenty-five studies were run in ICUs [ 12 , 30 – 33 , 35 – 44 , 46 , 57 , 59 – 62 , 64 – 66 ], 14 in rehabilitative settings [ 34 , 45 , 47 – 56 , 58 , 61 ] (Additional file 1 : Table S1). In 8 studies the cause of the injury was not specified [ 33 , 43 , 47 , 49 , 51 , 53 , 54 , 58 ], all the remaining studies enrolled traumatic SCI patients, 2 of them [ 55 , 61 ] enrolled both traumatic and a few non-traumatic patients, whose outcomes were not separable.…”

Traumatic Spinal Injury among Patients with Spinal Injuries Admitted to the Spine Unit of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…In a study from the national trauma centre in Nepal, fall injury was the most frequent mode of injury representing 83.3% followed by MVA. 6 With the increasing number of road traffic accidents, Motor Vehicle Accident (MVA) has been projected as a major aetiology of spinal cord injury in Nepal and other developing countries. 7 MVA contributes to 59.5% of spinal cord injuries in other Asian countries.…”

Critical Care Management of Fracture Dislocation of Cervical Spine: A Case Report

“…definitive spinal cord injury treatment, patients must undergo rehabilitation for continued neurological recovery. Patients must learn mobilization and selfcare techniques to help improve functional abilities.Rehabilitation can usually start early in the ICU and requires a multidisciplinary team 12. the intensive care unit, especially in airway management and respiratory support, in addition to addressing the potentially catastrophic multisystem sequelae of nerve damage.…”