The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania

Rashid, Sakina Mehboob; Jusabani, Mubashir; Mandari, Faiton Ndesanjo; Dekker, Marieke C. J.

doi:10.1038/scsandc.2017.21

Cited by 18 publications

(7 citation statements)

References 16 publications

(16 reference statements)

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“…24 Overall, in-hospital mortality rates for patients with SCI range from 4.0% to 24.1%, depending on the country (7.5% in the United States), type of hospital, and mechanism of injury. 9,17,22,34,39 Jain et al analyzed a cohort of 63,109 traumatic SCI patients from the United States National (Nationwide) Inpatient Sample database and identified a significant decrease in mortality in the patients older than 85 years of age, from 24.2% in 1993 to 20.1% in 2012. 22 These findings are promising, but these reported mortality rates include all admitted SCI patients, regardless of whether conservative, surgical, or comfort measures were taken.…”

Section: Discussionmentioning

confidence: 99%

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Lau

Ore

Tarapore

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.

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Section: Discussionmentioning

confidence: 99%

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Lau

Ore

Tarapore

et al. 2019

Neurosurgical Focus

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“…While other centers offer decompressive spinal surgery, this does not include the use of spinal implants to treat acute spinal trauma. 12 , 13 We used prior reports to estimate the TSI burden in Tanzania and neighboring countries of 154 patients per year with a 40% surgical rate. 11 …”

Section: Methodsmentioning

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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“…19,21,22 Many LMIC regions report low rates of operative treatment for CST due to lack of equipment and implants. 4,23,24 Given the devastating effects of CST in lessresourced environments, an epidemiologic investigation is needed to better understand this patient population. In a population of CST patients from a major East Africa referral center, our objectives were to (a) describe the presentation and operative treatment patterns, (b) report predictors of neurologic improvement, and (c) assess predictors of mortality.…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality

et al. 2021

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Background: Cervical spine trauma (CST) leads to devastating neurologic injuries. In a cohort of CST patients from a major East Africa referral center, we sought to (a) describe presentation and operative treatment patterns, (b) report predictors of neurologic improvement, and (c) assess predictors of mortality.Methods: A retrospective, cohort study of CST patients presenting to a tertiary hospital in Dar Es Salaam, Tanzania, was performed. Demographic, injury, and operative data were collected. Neurologic exam on admission/ discharge and in-hospital mortality were recorded. Univariate/multivariate logistic regression assessed predictors of operative treatment, neurologic improvement, and mortality.Results: Of 101 patients with CST, 25 (24.8%) were treated operatively on a median postadmission day 16.0 (7.0-25.0). Twenty-six patients (25.7%) died, with 3 (12.0%) in the operative cohort and 23 (30.3%) in the nonoperative cohort. The most common fracture pattern was bilateral facet dislocation (26.7%). Posterior cervical laminectomy and fusion and anterior cervical corpectomy were the 2 most common procedures. Undergoing surgery was associated with an injury at the C4-C7 region versus occiput-C3 region (odds ratio [OR] 6.36, 95% confidence interval [CI] 1.71-32.28, P ¼ .011) and an incomplete injury (OR 3.64; 95% CI 1.19-12.25; P ¼ .029). Twelve patients (15.8%) improved neurologically, out of the 76 total patients with a recorded discharge exam. Having a complete injury was associated with increased odds of mortality (OR 11.75, 95% CI 3.29-54.72, P , .001), and longer time from injury to admission was associated with decreased odds of mortality (OR 0.66, 95% CI 0.48-0.85, P ¼ .006).Conclusions: Those most likely to undergo surgery had C4-C7 injuries and incomplete spinal cord injuries. The odds of mortality increased with complete spinal cord injuries and shorter time from injury to admission, probably due to more severely injured patients dying early within 24-48 hours of injury. Thus, patients living long enough to present to the hospital may represent a self-selecting population of more stable patients. These results underscore the severity and uniqueness of CST in a less-resourced setting.Level of Evidence: 4.

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The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania

Abstract: The majority of patients affected by TSCIs were young males and the most common cause was fall injuries. Cervical level injuries were the most common and in-hospital mortality was high.

Cited by 18 publications

References 16 publications

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury

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

Cervical Spine Trauma in East Africa: Presentation, Treatment, and Mortality

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