On-line version ISSN 2078-5151
S. Afr. j. surg. vol.50 n.1 Cape Town Feb. 2012
Kawu A. AhidjoI; Salami A. OlayinkaII; Olawepo AyokunleIII; Alimi F. MustaphaIV; Gbadegesin A. A. SulaimanIV; Adebule T. GbolahanIV
IUniversity of Abuja Teaching Hospital, Gwagwalada, Federal Capital Territory, Nigeria
IINational Orthopaedic Hospital, Yaba, Lagos, Nigeria
IIIDepartment of Anatomy, University of Ilorin, Ilorin, Nigeria
IVNational Orthopaedic Hospital, Yaba
BACKGROUND: Well-organised and efficient prehospital transport is associated with an improved outcome in trauma patients. In Nigeria there is a paucity of information on prehospital transport of spinal cord-injured patients and its relation to mortality.
OBJECTIVE: To determine whether prehospital transportation is a predictor of mortality in spinal cord-injured patients in Nigeria.
DESIGN: Prospective cohort study.
METHODS: Prehospital transport-related conditions, injury-to-arrival intervals and persons who brought spinal cord-injured patients to the casualty departments at the University of Abuja Teaching Hospital, Gwagwalada, and the National Orthopaedic Hospital, Lagos, were noted. Data were analysed using descriptive statistics, the chi-square test and multiple logistic regressions.
MAIN OUTCOME MEASURES: Mortality within 6 weeks of admission.
RESULTS: During the review period, 168 patients with spinal cord injury presented to the casualty departments. Most presented 24 hours or more after the injury (67.9%) and were brought to casualty by their relatives (58.3%). Saloon cars were the most common mode of transportation (54.2%), most patients (55.4%) lying on their back during transfer. The majority of the patients (75%) had been taken to at least one other hospital before arriving at our casualty departments. The mortality rate was 16.7%. Multivariate analysis after adjusting for age, gender and means of transportation revealed that age (odds ratio (OR) 63.41, 95% confidence interval (CI) 9.24 -43.53), a crouched position during transfer (OR 23.52, 95% CI 7.26 - 74.53), presentation after 24 hours (OR 5.48, 95% CI 3.20 - 16.42) and multiple hospital presentations (OR 7.94, 95% CI 1.89 - 33.43) were associated with death within 6 weeks of admission.
CONCLUSION: Well-organised and efficient prehospital transport would reduce mortality in spinal cord-injured patients. Providing information on prehospital transport would also reduce mortality.
“Full text available only in PDF format”
1. Odeku EI, Richard RD. Peculiarities of spinal trauma in Nigeria. West Afr J Med 1971;20:211-225. [ Links ]
2. Solagberu BA. Spinal cord injuries in Ilorin, Nigeria. West Afr J Med 2002;21:230-232. [ Links ]
3. Obalum DC, Giwa SO, Adekoya-Cole TO, Enweluzo GO. Profile of spinal injuries in Lagos, Nigeria. Spinal Cord 2008, Aug. http://www.ncbi.nlm.nih.gov/sites/entrez (accessed 6 September 2008). [ Links ]
4. Olasode BJ, Komolafe IE, Komolafe M, Olasode OA. Traumatic spinal cord injuries in Ile-Ife, Nigeria, and its environs. Trop Doct 2006;36:181-182. [ Links ]
5. Umaru H, Ahidjo A. Pattern of spinal cord injury in Maiduguri, North Eastern Nigeria. Niger J Med 2005;14:276-278. [ Links ]
6. Nwadinigwe CU, Iloabuchi TC, Nwabude IA. Traumatic spinal cord injuries (SCI): a study of 104 cases. Niger J Med 2004;13:161-165. [ Links ]
7. Igun GO, Obekpa OP, Ugwu BT, Nwadiaro HC. Spinal injuries in Plateau State, Nigeria. East Afr Med J 1999;76:75-79. [ Links ]
8. Okonkwo CA. Spinal cord injuries in Enugu, Nigeria - preventable accidents. Paraplegia 1988;26:12-18 [ Links ]
9. Bouamra O, Wrotchford A, Hollis S, Vail A, Woodford M, Lecky F. Outcome prediction in trauma. Injury 2006;37:1092-1097. [ Links ]
10. Furlan JC, Krassioukov AV, Fehlings MG. The effects of gender on clinical and neurological outcomes after acute cervical spinal cord injury. J Neurotrauma 2005;22:368-381. [ Links ]
11. Bakers SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187-196. [ Links ]
12. Coelho DG, Brasil AV, Ferreira NP. Risk factors of neurological lesions in low cervical spine fractures and dislocations. Arq Neuropsiquiatr 2000;58:1030-1034. [ Links ]
13. Gabbe BJ, Cameron PA, Wolfe R. TRISS: does it get better than this? Acad Emerg Med 2004;11:181-186. [ Links ]
14. Gabbe BJ, Cameron PA, Wolfe R, Williamson OD, Cameron PA. Predictors of mortality, length of stay and discharge destination in blunt trauma. Aust N Z J Surg 2005;75:650-656. [ Links ]
15. George RL, McGwin Jr G, Metzger J, Chaudry IH, Rue III LW. The association between gender and mortality among trauma patients as modified by age. J Trauma 2003;54:464-471. [ Links ]
16. Liang HW, Wang YH, Lin YN, Wang JD, Jang Y. Impact of age on the injury pattern and survival of people with cervical cord injuries. Spinal Cord 2001;39:375-380. [ Links ]
17. Neumann CR, Brasil AV, Albers F. Risk factors for mortality in traumatic cervical spinal cord injury: Brazillian data. J Trauma 2009;67:67-70. [ Links ]
18. Claxton AR, Wong DT, Chug F, Fehlings MG. Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Can J Anaesth 1998;45:144-149. [ Links ]
19. Pull ter Gunne AF, Aquarius AE, Roukema JA. Risk factors predicting mortality after blunt traumatic cervical fractures. Injury 2008;39:1437-1441. [ Links ]
20. Cusick JF, Yoganandan N. Biomechanics of the cervical spine 4: major injuries. Clin Biomech (Bristol, Avon) 2002;17(1):1-20. [ Links ]
21. Goldberg W. Mueller C, Panacek E, Tigges S, Hoffman JR, Mover WR. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med 2001;38:17-21. [ Links ]
22. Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 1988;44:804-812. [ Links ]
23. Adeyemi-Doro HO, Sowemimo GOA. Optimal care for trauma victims in Nigeria. Trauma Quarterly 1999;14:295-300. [ Links ]
24. Solagberu BA, Ofoegbu CKP, Abdur-Rahman LO, Adekanye AO, Udoffa US, Taiwo J. Pre-hospital care in Nigeria: a country without emergency medical services. Nig J Clin Pract 2009;12:29-33. [ Links ]
25. Forjouh S. Transport of the injured to the hospitals in Ghana: the need to strengthen the practice of trauma care. Pre-hospital Immediate Care 1999;3:66-70. [ Links ]
26. Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ 2002;324:1139-1141. [ Links ]