Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa

Abstract

Study design A prospective, regional, population-based study.Objectives (1) Determine the mortality rate and factors associated with it 4 years after a TSCI and (2) The point prevalence of secondary medical complications of survivors at 4 years. Setting Communities of the Cape metropolitan area, South Africa. Methods All persons (n = 145) sustaining a TSCI from 15 September 2013 to 14 September 2014 were eligible for followup at 4 years. Participants were contacted after 4 years. The next of kin, via verbal autopsy, was used to establish cause of death. Those who were alive at 4 years were asked to indicate any secondary medical complications. Logistic regression techniques were used to identify independently associated risk indicators for death and development of secondary complications, respectively. Results Of the initial 145 persons, 87 were included and accounted for. Of these, 21 (24%) had died, 55 (63%) were alive and completed the survey, and 11 (13%) were classified as alive but did not submit the survey. The main cause of death reported was septicaemia (n = 7; 33%), followed by unknown natural causes (n = 7; 33%), then pressure injuries (n = 5; 24%). Out of the 55 persons alive, 89% had at least one medical complication at the time of enquiry, while more than 50% experienced 6 or more complications. The most common complications were pain (80%), muscle spasms (76%), sleeping problems (56%), and bladder dysfunction (44%). Conclusions Almost one-quarter of persons with TSCI have died 4 years after injury. Also, secondary complications were found to be highly prevalent at 4 years. This information could be used to develop secondary complications prevention programmes to reduce premature deaths.

Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: A qualitative study

“…The participants experienced a range of SHCs, but the most prevalent SHC was pain (94%). Pain is the most pervasive and significant problem throughout a person’s lifespan with SCI (Madasa et al 2020 ; Piatt et al 2016 ). When patients report pain symptoms their focus is not on the severity and the location of the pain but the different facets of life affected by pain, namely mental health, physiological impairments and personal behaviour (Müller et al 2017 ; Yorkston et al 2010 ).…”

“…Participants were afraid to leave their homes because of the fear of bladder and bowel leakage. Bowel and bladder problems are problematic SHCs in people with SCI (Piatt et al 2016), with a prevalence of 44% bladder dysfunction and 42% bowel dysfunction 4 years post-SCI in South Africa (Madasa et al 2020). A study conducted in Ghana reported that patients with SCI did not want to participate in social events, such as weddings because of bowel and bladder http://www.sajp.co.za Open Access incontinence for fear of leakage in public.…”

“…The different estimates could be because of the participants having different SCI profiles. Post rehabilitation estimates of SHCs are higher: 89% in South Africa (Madasa et al 2020 ) and 98.5% in the Netherlands (Adriaansen et al 2016 ). Given the high prevalence of SHCs post-rehabilitation, it is worth exploring how people with SCI experience SHCs.…”

“…In South Africa, studies on SHCs in people with SCI are limited and only three studies have reported on the occurrence of SHCs in the post-rehabilitation phase (Madasa et al 2020 ; Mashola & Mothabeng 2019 ; Mashola, Olorunju & Mothabeng 2019 ). These studies do not explore the experience of living with SHCs.…”

“…These studies do not explore the experience of living with SHCs. Madasa et al ( 2020 ) reported the mortality rate and the prevalence of SHCs amongst survivors at 4 years post-injury. Mashola et al ( 2019 ) reported on the high hospital readmission rates of patients with SCI because of SHCs and Mashola and Mothabeng ( 2019 ) on the impact of SHCs on quality of life.…”