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Published on: December 17, 2014
Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a
Ayodeji Salman Yusuf1, Muhammad Raji Mahmud1, Dumura Jeneral Alfin1
1Department of Surgery, Neurosurgery Unit, National Hospital Abuja, Abuja, Nigeria.
Insights
Traumatic spinal cord injury (TSCI) disproportionately affects young men, with motor vehicle crashes being the primary cause. Economic constraints and inadequate facilities significantly hinder optimal patient care and outcomes in resource-limited settings.
Area of Science:
- Trauma Care
- Neuroscience
- Public Health
Background:
- Traumatic spinal cord injury (TSCI) presents a significant global health challenge, particularly impacting young populations.
- Outcomes are influenced by injury severity, secondary insult prevention, and access to specialized care.
- Resource limitations, including prehospital care and insurance, negatively affect TSCI patient outcomes.
Purpose of the Study:
- To delineate the clinical profile of TSCI patients.
- To identify factors influencing early outcomes in a resource-constrained trauma center.
Main Methods:
- Retrospective review of trauma registry and medical records.
- Study conducted at the National Trauma Center Abuja from September 2014 to December 2016.
- Involved 133 patients with acute TSCI.
Main Results:
- The majority of TSCI patients were young males (mean age 36), with motor vehicle crashes as the leading cause (72.2%).
- Cervical spinal cord injuries were most common (62.0%); no patients received standard prehospital care.
- Complete spinal cord injuries (ASIA A) affected 52.6%, pressure ulcers were common (23.3%), and surgery was limited by cost (42% operated).
- Admission ASIA grade was the key determinant of morbidity and mortality.
Conclusions:
- Inadequate facilities and financial constraints impede optimal TSCI care.
- The study highlights the critical need for improved healthcare infrastructure and financial support for TSCI patients in similar settings.
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.
