TRAUMA

 

Prehospital transport of spinal cord-injured patients in Nigeria

 

 

Kawu A. Ahidjo^I; Salami A. Olayinka^II; Olawepo Ayokunle^III; Alimi F. Mustapha^IV; Gbadegesin A. A. Sulaiman^IV; Adebule T. Gbolahan^IV

^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

 

 

---

ABSTRACT

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”

 

REFERENCES

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 ]