Introduction: Traumatic spinal cord injury (SCI) is a relatively rare but devastating consequence of trauma, which affects an estimated 23 per 1 million people globally. Because an estimated 90% of the global trauma-related mortality occurs in low- and middle-income countries (LMICs), SCI is likely similarly disproportionate; however, studies on the incidence of SCI in LMICs are limited. We therefore sought to characterize spinal column and cord injury in our sub-Saharan African tertiary care center.
Methods: This is a retrospective review of prospectively collected data from Kamuzu Central Hospital, a tertiary care center serving 6 million people in the capital of Malawi. All patients admitted from October 2016 through February 2017 with a trauma-related mechanism of injury and a neurological deficit attributable to spinal cord injury or radiographic evidence of spinal column trauma were included.
Results: 42 patients met inclusion criteria (Table 1). Of these, 61.9% had spinal cord injuries. The most common mechanism of injury was fall (50.0%), most often with a head load. The mean time from injury to presentation was 2.9±7.8 days. Cervical spinal cord injuries were the most common (58.3%). The most common (46.2%) American Spinal Injury Association Score among patients with spinal cord injury was A (Complete Impairment). Radiographs (Figure 1) most commonly showed compression fractures (40.5%), fracture-dislocations (16.7%) and subluxations (16.7%). Mortality was 12.8%, and all patients who died had complete cervical spinal cord injuries. 58.8% of patients who survived to discharge had a good recovery on the Glasgow Outcome Scale, while 29.4% had moderate disability, and 11.8% had severe disability.
Conclusions: Traumatic spinal cord injury causes devastating morbidity and mortality. Due to the etiology, high mortality and relative lack of operative facilities, primary prevention of these types of injuries is the most effective way to attenuate SCI-related morbidity and mortality.
Patient Care: Continued development of our spinal injury database will provide the epidemiological data necessary to inform SCI prevention in our regions and others like it.
Learning Objectives: By the conclusion of this session, participants should be able to
1) Understand the global burden of SCI-related morbidity and mortality
2) Interpret preliminary results of sub-Saharan Africa based SCI database and apply them to potential prevention strategies.
References: 1.Lee BB, Cripps RA, Fitzharris M, Wing PC. The Global Map for Traumatic Spinal Cord Injury Epidemiology: Update 2011, Global Incidence Rate. Spinal Cord: 52(2) Epub.
2.Jazayeri SB, Beygi S, Shokraneh F, Hagen EM, Rahimi-Movaghar V. Incidence of Traumatic Spinal Cord Injury Worldwide: a Systematic Review. Eur Spine J: 24(5) 905-18
3.De Ramirez SS, Hyder AA, Herbert HK, Stevens K. Unintentional Injuries: Magnitude, Prevention, and Control. Annu Rev Public Health: 33, 175-91.