Spinal cord and spine trauma in a large teaching hospital in Ghana

Ametefe, Mawuli; Bankah, Patrick; Yankey, Kwadwo Poku; Akoto, Harry; Janney, D; Dakurah, Thomas

doi:10.1038/sc.2016.57

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…Although non-communicable diseases are still the leading causes of death outside the hospital, most of the deaths are due to road traffic accidents, and these numbers are systematically increasing (Akakpo et al, 2020) Research suggests that road traffic accidents cause 16% of injuries in urban areas and 10% in rural areas (C. N. . Ametefe indicates that 70.3% of spinal injuries at Korle Bu Teaching Hospital are caused by road accidents, especially in young men (Ametefe et al, 2016). Spinal injuries are the most dangerous consequences of road accidents.…”

Section: Health Hazards Resulted From the Poor Technical Conditionmentioning

confidence: 99%

Health hazards as a consequence of the poor technical condition of vehicles in Ghana

Wojtysiak

Zieliński

Wojsz

2021

HSSR

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Purpose: This is a review to assess the health hazards resulted from the poor technical condition of vehicles in Ghana. In developing countries, the number of vehicles involved in road traffic is systematically increasing. The health consequences of road accidents are a crucial public concern. Methodology: The PubMed and Google scholar search were used to find literature for this analysis. The following keywords were taken into consideration in this paper: health hazards, technical conditions, vehicles, accidents, developing countries, Ghana. The analysis has been done by the systematic review analysis method. The articles were selected in terms of the health hazards resulting from the poor technical condition of vehicles in Ghana and its effects on road safety. Twenty papers were being reviewed. Main findings: The quality of vehicles on Ghanaian roads is low. Most of the cars are old. For economic reasons, users often use substandard products to repair cars. Poor-quality, non-original, mismatched parts can lead to an accident. The technical condition of vehicles affects the safety of road users. The security of citizens should be an essential goal of the state. Inspections of the technical condition of cars, especially in public transport, should be strengthened and the frequency increased. Implications: Based on the analysis of the publications, it was assessed that there is no current literature on technical problems of vehicles in Ghana, with particular emphasis on public transport. This is an essential topic for the security of citizens and should be investigated, analyzed, and lessons learned without delay. Novelty in this study: There is a lack of systematic reviews of the impact of health hazards resulted from the poor condition of vehicles in Ghana. The paper is an attempt to assess the impact of the problem.

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Section: Health Hazards Resulted From the Poor Technical Conditionmentioning

confidence: 99%

Health hazards as a consequence of the poor technical condition of vehicles in Ghana

Wojtysiak

Zieliński

Wojsz

2021

HSSR

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“…TSI is a major health care burden that primarily affects young, active, males, leading to loss of manpower, decreased productivity, and death, all with economic implications. 6,28 We offer the following recommendations: Implementation of a spine trauma protocol: A triage system where incomplete SCI patients are prioritized for the OR should be implemented. Efforts to implement a “Spine Trauma Protocol” at MOI are currently ongoing. Spinal implant availability: Spinal implants should be available for all patients, regardless of their ability to pay.…”

Section: Discussionmentioning

confidence: 99%

Section: Future Recommendationsmentioning

confidence: 99%

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Magogo

Lazaro

Mango

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objective: Little is known about operative management of traumatic spinal injuries (TSI) in low- and middle-income countries (LMIC). In patients undergoing surgery for TSI in Tanzania, we sought to (1) determine factors involved in the operative decision-making process, specifically implant availability and surgical judgment; (2) report neurologic outcomes; and (3) evaluate time to surgery. Methods: All patients from October 2016 to June 2019 who presented with TSI and underwent surgical stabilization. Fracture type, operation, neurologic status, and time-to-care was collected. Results: Ninety-seven patients underwent operative stabilization, 23 (24%) cervical and 74 (77%) thoracic/lumbar. Cervical operations included 4 (17%) anterior cervical discectomy and fusion with plate, 7 (30%) anterior cervical corpectomy with tricortical iliac crest graft and plate, and 12 (52%) posterior cervical laminectomy and fusion with lateral mass screws. All 74 (100%) of thoracic/lumbar fractures were treated with posterolateral pedicle screws. Short-segment fixation was used in 86%, and constructs often ended at an injured (61%) or junctional (62%) level. Sixteen (17%) patients improved at least 1 ASIA grade. The sole predictor of neurologic improvement was faster time from admission to surgery (odds ratio = 1.04, P = .011, 95%CI = 1.01-1.07). Median (range) time in days included: injury to admission 2 (0-29), admission to operating room 23 (0-81), and operating room to discharge 8 (2-31). Conclusions: In a cohort of LMIC patients with TSI undergoing stabilization, the principle driver of operative decision making was cost of implants. Faster time from admission to surgery was associated with neurologic improvement, yet significant delays to surgery were seen due to patients’ inability to pay for implants. Several themes for improvement emerged: early surgery, implant availability, prehospital transfer, and long-term follow-up.

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“… 5 Due to insufficient funds, many patients are relegated to nonoperative care, consisting of bed rest for 3 months. 6 - 8 Case series from Nigeria 9 and Ghana 10 report operative rates ranging from 47% to 57% in patients with surgical indications. While implants have a high upfront cost, the value of spine trauma surgery may be realized through achieving early mobilization, neurologic improvement, and return to wage-earning jobs.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center

Lessing

Zuckerman

Lazaro

et al. 2020

Global Spine Journal

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Study Design: Retrospective cost-effectiveness analysis. Objectives: While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting. Methods: At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life). Results: A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences. Conclusions: This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care.

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Spinal cord and spine trauma in a large teaching hospital in Ghana

Cited by 21 publications

References 19 publications

Health hazards as a consequence of the poor technical condition of vehicles in Ghana

Health hazards as a consequence of the poor technical condition of vehicles in Ghana

Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center

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