LEVEL OF PRE-TERTIARY CARE HOSPITAL MANAGEMENT OF TRAUMATIC SPINAL CORD INJURED PATIENTS; WHERE DO WE STAND?
Abstract
Background: Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. Methods: This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. Results: Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10–70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. Conclusion: There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities.References
Ala'a OO, Smith K, Jennings PA, Stoelwinder JU. The prehospital management of suspected spinal cord injury: an update. Prehosp Disaster Med 2014;29(4):399–402.
Galeiras Vázquez R, Ferreiro Velasco ME, Mourelo Fariña M, Montoto Marqués A, Salvador de la Barrera S. Update on traumatic acute spinal cord injury. Part 1. Med Intensiva 2017;41(4):237–47.
Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord 2014;52(2):110–6.
Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol 2014;6:309–31.
Bernhard M, Gries A, Kremer P, Böttiger BW. Spinal cord injury (SCI)—prehospital management. Resuscitation 2005;66(2):127–39.
Pickett W, Simpson K, Walker J, Brison RJ. Traumatic spinal cord injury in Ontario, Canada. J Trauma 2003;55(6):1070–6.
Hadly MN. The Section on Disorders of the Spine and peripheral nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Guidelines for management of acute cervical spinal injuries. Neurosurgery 2002;50(Suppl):S7–17
Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery 2013;72(Suppl_3):22–34.
Hadley MN, Walters BC. Introduction to the guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery 2013;72(Suppl_3):5–16.
Ahn H, Singh J, Nathens A, MacDonald RD, Travers A, Tallon J, et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011;28(8):1341–61.
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to thecervical spine in patients with blunt trauma. National Emer-gency X-Radiography Utilization Study Group. N Engl J Med 2000;343:94–9.
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286(15):1841–8.
Sanchez AR, Sugalski MT, LaPrade RF. Field-side and prehospital management of the spine-injured athlete. Curr Sports Med Rep 2005;4(1):50–5.
Waninger KN, Swartz EE. Cervical spine injury management in the helmeted athlete. Curr Sports Med Rep 2011;10(1):45–9.
Yue JK, Winkler EA, Rick JW, Deng H, Partow CP, Upadhyayula PS, et al. Update on critical care for acute spinal cord injury in the setting of polytrauma. Neurosurg Focus 2017;43(5):E19.
Catapano JS, John Hawryluk GW, Whetstone W, Saigal R, Ferguson A, Talbott J, et al. Higher mean arterial pressure values correlate with neurologic improvement in patients with initially complete spinal cord injuries. World Neurosurg 2016;96:72–9.
Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Ryken TC, Walters BC, Hadley MN. Transportation of patients with acute traumatic cervical spine injuries. Neurosurgery 2013;72(Suppl_3):35–9.
Blake WE, Stillman BC, Eizenberg N, Briggs C, McMeeken JM. The position of the spine in the recovery position--an experimental comparison between the lateral recovery position and the modified HAINES position. Resuscitation 2002;53(3):289–97.
Khan KM, Jamil M, Memon IA, Idrees Z. Pattern of injuries in motorbike accident. J Pak Orthop Assoc 2018;30(3);123–7.
Gill ZA, Ahmed N, Akhtar N, Hanif S, Butt AW. Pattern of traumatic spinal cord injuries in Pakistan Armed Forces. Med Chan 2012:18(1);77–9.
Rahimi-Movaghar V, Sayyah MK, Akbari H, Khorramirouz R, Rasouli MR, Moradi-Lakeh M, et al. Epidemiology of traumatic spinal cord injury in developing countries: a systematic review. Neuroepidemiology 2013;41(2):65–85.
Oliveira TAB de, Andrade SM dos S, Prado GO, Fernandes RB, Gusmão MS, Gomes EGF, et al. Epidemiology of spine fractures in motorcycle accident victims. Coluna/Columna 2016;15(1):65–7.
Obalum DC, Giwa SO, Adekoya-Cole TO, Enweluzo GO. Profile of spinal injuries in Lagos, Nigeria. Spinal Cord 2009;47(2):134–7.
Page PS, Wei Z, Brooks NP. Motorcycle helmets and cervical spine injuries: a 5-year experience at a Level 1 trauma center. J Neurosurg Spine 2018;28(6):607–11.
Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Sosa-Henríquez M. Change in the profile of traumatic spinal cord injury over 15 years in spain. Scand J Trauma Resusc Emerg Med 2018;26(1):27.
Ter Wengel PV, De Haan Y, Feller RE, Oner FC, Vandertop WP. Complete traumatic spinal cord injury: current insights regarding timing of surgry and level of injury. Global Spine J 2020;10(3):324–31.
Ahidjo KA, Olayinka SA, Ayokunle O, Mustapha AF, Sulaiman GA, Gbolahan AT. Prehospital transport of spinal cord-injured patients in Nigeria. S Afr J Surg 2012;50(1):3–5.
Connor D, Greaves I, Porter k, Bloch M. Pre-hospital spinal immobilization: an initial consensus statement. Trauma 2013;30(12):1067–9.
Guly HR, Bouamra O, Lecky FE. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation 2008;76(1):57–62.
Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, et al. Transportation of patients with acute traumatic cervical spine injuries. Neurosurgery.2013;72(Suppl 2):35–9.
Lodhi A, Khan SA, Ahmed E, Fatima S, Fatima F, Pasha T, et al. Pre-hospital management of spinal injuries in a natural disaster. J Ayub Med Coll Abbottabad 23(4):10–2.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
