Pattern and outcome of spinal injury at Kenyatta National Hospital

Abstract

Background: Spinal injuries constitute a significant portion of the injuries sustained after trauma and are responsible for significant morbidity and mortality. Determination of the current burden of spinal injuries in Kenya has not been done and will enable development of effective prevention and treatment measures. Methods: Spinal injury victims meeting the inclusion criteria were recruited consecutively between August 2013 and January 2014 to a sample size of forty nine patients. Independent variables were recorded on pretested standard forms. The recruited patients were then followed up for a period of three months to determine outcome measures. Results: A total of 49 patients were admitted during a 6 month period. The mean age was 37.6 years (14 – 70) with a male to female ratio was 15.3:1. Road Traffic Accident was the most common cause of injury (55%). Fifty five percent of the patients had a cervical spine injury with C5 being the most commonly injured vertebrae. The overall 3 month mortality rate was 40.8% with average time between injury and death being 129 hours. Forty eight point three percent of patients had a pain grade of 2 or more at the end of the 3 months. Thirty eight percent of the patients who survived to 3 months had American Spinal Injury Association (ASIA) Impairment Scale (AIS) A – complete injury. Forty four point eight percent of patients developed bed sores by three months. It was determined that the greatest positive correlation with mortality was use of alcohol, and high neurologic level of injury. The smoking status, presence of comorbid conditions and alcohol use had no influence on the percentage change in AIS. Conclusions: Spinal injury constitutes a significant disease burden at KNH affecting males in the most economically productive age group as a consequence of road traffic accident thus road safety initiatives should be intensified to reduce the number of spinal injuries. Improvement in the emergency response infrastructure and development of clear and concise referral criteria for the lower level hospitals will ensure timely management of spinal injuries. Establishment of more spine centers, training of more spine surgery personnel and provision of cost effective spinal surgery implants will improve the management of spine injuries