Care Related and Transit Neuronal Injuries Following Cervical Spine Trauma: State of care and practice in Nigeria.
J Neurotrauma. 2013 Jun 13;
Authors: Mezue WC, Onyiah E, Iloabachie IC, Chikani MC, Ohaegbulam SC
Suboptimal care during extraction and transfer following spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors contributing to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire based prospective study of patients admitted with cervical cord injury to two Neurosurgical centres in Enugu, Nigeria between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation and treatment received before arriving at neurosurgical unit were analysed. There were 53 (77.9%) males, the mean age was 33.9 years and 23.5% had concomitant head injury. Average delay was 3.5 hours between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centres with trauma services. About 94.1% were extracted by passers-by. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care and 35.3% were sitting in a motor vehicle or supported on a bike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of saloon cars and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centres, only 36% had cervical support although 78% were transported in ambulances. Ignorance of pre-hospital management of cervical injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services and public enlightenment.
PMID: 23758277 [PubMed – as supplied by publisher]