Epidemiology and Clinical Management of Traumatic Spine Injuries at a Major Government Hospital in Cambodia

Abstract

Study DesignCross sectional study.PurposeTo characterize the pattern of injury, describe the current clinical management, and determine the outcomes in traumatic spine injury (TSI) patients presenting to a major government hospital in Phnom Penh, Cambodia.Overview of LiteratureThere is a paucity of literature on epidemiology or current clinical practices for TSIs in Cambodia. The findings from this study can thus serve as a valuable resource for future progress in treating TSIs in low-income countries.MethodsThis study was a cross-sectional study of TSI patients admitted to Preah Kossamak Hospital in Phnom Penh, Cambodia. Demographics, cause of spinal injury, spinal level of injury, surgical procedures and techniques, complications, and American Spinal Injury Association (ASIA) grades were recorded and analyzed.ResultsEighty patients were admitted with TSI between October 2013 and June 2014. Falls from heights were the most common cause of TSI, followed by road traffic accidents. 78% of the admitted patients underwent at least one surgical procedure. Without intraoperative imaging, 4 patients (6%) had wrong level surgery, and 1 patient (2%) had misplacement of pedicle screws. Sacral decubitus ulcers were the most common non-surgically related complication. Antibiotics were administered to >90% of patients. There were no in-hospital mortalities. Of the 60 spinal cord injury (SCI) patients, 32% (19/60) showed improvement in their ASIA grade at the time of discharge, and 52% (31/60) showed no change. At follow-up, 32% (19/60) of SCI patients reported improvement, and 8% (5/60) reported no change. However, 36 SCI patients (60%) were lost to follow-up.ConclusionsDespite technological limitations, outcomes of TSI patients in Cambodia appear favorable with evidence of clinical improvement and low mortality.

Epidemiologic Aspects of Spinal Cord Trauma Cases among Traffic Accident Victims

“…Men were the predominant victims of SCT, corroborating several studies [6,7,11,43,45]. The average age in this study is in agreement with other ones previously performed [7,10,12,44,45]. Being male, young, using alcohol and illicit drugs are the main risk factors associated with this type of injury [50].…”

“…More than two thirds of the victims in the population of this study had spinal injury, a result similar to that described in Cambodia [44] and higher than reported in China [6] and Iran [12]. The incidence of this injury, as found in this study, can be considered high when compared to others [2,11,49], which makes this situation even more worrying in this locality.…”

“…Regarding the classification according to the ASIA Scale, our study differs from others ones who also made this assessment, which verified the predominance of ASIA A [10,44,45] and ASIA D [49]. Paraplegia was predominant over quadriplegia, and such conditions were only evident in victims who were classified as ASIA A.…”

“…Regarding the SCT, the cervical region has also been described in other studies [7,9,11,43] as the most damaged skeletal level, includingafter motorcycle accidents [44]. Concerning accidents involving automobiles, injury in the lumbar region was predominant [12].…”

“…Regarding the predominance of the most affected vertebra, other studies show different results, being L1 the more frequent [6,44] and most lesions were between Th1 and S5 [49], which shows the importance of knowledge about these characteristics in a given population, generating subsidies for decision-making regarding specific prevention actions, such as the use of cervical collars in initial care by health professionals, and guidance on the importance of the use of head restraints and seat belts in automobiles. These actions may decrease the risk of a cervical injury.…”