Two-year survival following discharge from hospital after spinal cord injury in Bangladesh

Abstract

Study design: Mixed retrospective-prospective cohort study. Objectives: To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh. Setting: Bangladesh. Methods: Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy. Results: 350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers. Conclusion: In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

Psychological and socioeconomic status, complications and quality of life in people with spinal cord injuries after discharge from hospital in Bangladesh: a cohort study

“…These data align with the mortality data from our larger cohort, which indicated that 56% of the 55 deaths in the first 2.5 years following discharge were due to pressure ulcers. 8 Pressure ulcers are clearly one of the biggest health risks for people with SCI in LMICs. 22,23 The participants in this cohort had all received comprehensive education about low cost strategies to prevent pressure ulcers during their inpatient rehabilitation.…”

“…The methods and survival data have been published elsewhere. 8 In brief, all patients admitted with SCI to a large hospital in Bangladesh in 2011 were followed up by telephone in 2014. Consequently, the study was a mixed retrospective-prospective cohort study.…”

A pilot randomised trial of community-based care following discharge from hospital with a recent spinal cord injury in Bangladesh

“…We had similar success finding participants two years after discharge in our earlier cohort study. 7 In that trial we were able to locate and determine outcomes for 97% of 350 participants. Our success in following up participants is in contrast to the low follow-up rates often reported in studies conducted in high-income countries.…”

Telephone-based management of pressure ulcers in people with spinal cord injury in low- and middle-income countries: a randomised controlled trial

“…Pressure ulcers for this group of people are a major cause of mortality and misery and receive very little research attention. 6,31 The primary aim of this trial was to determine the effects of a 12-week telephone-based pressure ulcer management programme on pressure ulcer size in people with SCI. The results for the primary outcome (size of pressure ulcer) failed to provide a clear answer to our research question; however, the results do not rule out the possibility that advice about pressure ulcer management provided over the telephone may be a worthwhile intervention (mean betweengroup difference = 2.3 cm 2 ; 95% CI − 0.3 to 4.9).…”

“…5 A large cohort study from Bangladesh reported that one in five people with SCI who were wheelchair dependent had died within 2 years of discharge from hospital, mostly from pressure ulcers (2-year survival was 81%; 95% confidence interval (CI) 76-86%). 6 Given the high rates of postdischarge mortality in LMICs, finding effective, low-cost and locally applicable treatment options for the management of pressure ulcers is a key part of improving levels of care for people with SCI globally. 5 There is a large divide between the management of pressure ulcers in high-income countries compared with the management in LMICs.…”