Epidemiological Characteristics of Dorsal and Lumbar Spine Trauma Presenting to a Trauma Hospital in Kathmandu, Nepal: Formulation of a National Spine Policy

Dhakal, Gaurav Raj; Paudel, Santosh; Dhungana, S; Gurung, Ganesh; Kawaguchi, Yoshiharu

doi:10.22603/ssrr.2017-0087

Cited by 6 publications

(12 citation statements)

References 9 publications

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“…The global incidence of SCI is estimated to be between 10.4 and 83 per million individuals per year [ 1 ], with a male predominance [ 1 – 7 ]. Such a large range demonstrates difficulty in collating epidemiological SCI data globally; particularly in LMICs as data collection is difficult due to lack of national trauma databases [ 1 , 6 , 8 , 9 ]. SCI appears to be greater problem in LMICs; incidence is reportedly four times that in high-income countries [ 10 ] with a higher mortality rate [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature

Solomon

Dhakal²,

Halpin

et al. 2022

Spinal Cord

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Study design Systematic review. Objective To systematically review the evidence for the effectiveness of telerehabilitation as an intervention for people with spinal cord injury (SCI) in low-and middle-income countries (LMICs). Setting Not applicable. Methods MEDLINE (Ovid), Embase (Ovid), Pubmed and Global Health databases were used to identify studies published between 1946–2020 meeting the following criteria: (1) patients with SCI diagnosis; (2) in LMIC; (3) an outcome measuring clinical functional ability, quality of life or all-cause mortality reduction. The risk of bias in studies was graded using revised Cochrane risk-of-bias tool in randomised trials (RoB 2) and risk-of-bias tool in non-randomised trials (ROBINS-I). Evidence levels were graded with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results In total, 107 articles were identified from the initial search. After screening, five studies were included. Some significant improvements to quality of life and pressure ulcer management were observed, alongside some improvement in functional ability with suggested improvement to depression scores. Telerehabilitation alleviated participants’ sense of social isolation, improved satisfaction scores and assisted them to remember techniques for SCI management. Telerehabilitation was valued by health professionals. There was no reduction in all-cause mortality. Conclusion There is insufficient evidence to recommend telerehabilitation as an intervention to treat and manage SCI in LMICs, although there is an indication of potential patient benefit. Further research is required to better understand the causal mechanisms underpinning the use of telerehabilitation and establish its efficacy, in the context of resource-limited settings.

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Section: Introductionmentioning

confidence: 99%

Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature

Solomon

Dhakal²,

Halpin

et al. 2022

Spinal Cord

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“…43,44 Delayed access to hospital for treatment is another major observation from the review that demands further discussion (38% patients arriving at the hospital after 48 hours of trauma). 17 Unlike the studies in western countries where delay is due to treatment of other associated injuries in referring hospital and late diagnosis, 45 the studies in Nepal have not explained the causes. To speculate, the cause of delay can be difficult terrain, lack of proper transportation, proximity to hospital facility and financial constraints.…”

Section: Discussionmentioning

confidence: 99%

“…Comparing the studies before and after 2017, a significant shift to surgical management in recent years was observed. Only 25.4% of 1312 patients were managed surgically in the studies before 2017 -Bajracharya et al 13 Shrestha et al 16 and Devkota et al 20 But, in the studies after 2017 which included a total of 437 patients, 14,15,17,18,21 the share of surgically managed patients was found to be 76.7%. 17,18 with a cumulative total patients to improve by one ASIA grade being 105 (32%) in all four studies.…”

Section: Treatment Modalitymentioning

confidence: 98%

“…In terms of the setting, one study was done in BP Koirala Institute of Health Sciences (BPKIHS), Dharan; 13 two in Spinal Injury Rehabilitation Centre (SIRC), Kavre; 14,16 two in National Trauma Centre (NTC), Kathmandu; 17,18 one in College of Medical Sciences (COMS) Chitwan; 15 one in Green Pasture Hospital and Rehabilitation Centre (GPHRC), Pokhara; 19 one in Gandaki Medical College (GMC), Pokhara; 20 and one in Nobel Medical College (NMC), Biratnagar. 21 None of them represent studies from the western part of Nepal.…”

Section: Types Of Studies and Their Propertiesmentioning

confidence: 99%

“…Only two of the included studies 17,18 mentioned the duration of trauma to hospital arrival. Of the total 121 patients in those studies, 62% arrived within 2 days followed by 29% within 3 days to 7 days, and the remaining 9 % patients arrived after 7 days of trauma.…”

Section: Arrival To Hospitalmentioning

confidence: 99%

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Epidemiology of traumatic spinal cord injury in Nepal: A systematic review

2020

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Spinal cord injury (SCI) leads to disabling condition. In Nepal the nationwide statistics of incidence and prevalence of SCI is still unclear which demands a systematic examination of crucial epidemiological aspects of SCI. An electronic search was conducted on PubMed, Ovid EMBASE, Cochrane Library and Google Scholar. Clinical studies investigating epidemiology of spinal cord injury were included. A narrative synthesis of the data that comprised 1796 patients was conducted. Males comprised 73%, and the mean age varied from 32 to 47 years. The two leading causes of SCI were falls (60%) and accidents (17%). Most patients had incomplete neurology (AIS grade B, C and D = 42%) followed by AIS A grade (36.3%). Cervical injury (37.4%) was the most common level of injury. Mortality during hospital stay was low (1.98%) whereas after rehabilitation was high (24.32%). The review contributes in understanding epidemiology of SCI in Nepal which is expected to help in planning for prevention and management.

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