MORTALITY AND ITS ASSOCIATED FACTORS IN PATIENTS WITH SPINAL CORD INJURIES AT PARAPLEGIC CENTER PESHAWAR, PAKISTAN
PDF

Keywords

Death
Pressure Ulcers
Spinal Cord Injuries
Rehabilitation

How to Cite

Arsh, A., Darain, H., Zeb, A., Ilyas, S., & Khalid, S. (2019). MORTALITY AND ITS ASSOCIATED FACTORS IN PATIENTS WITH SPINAL CORD INJURIES AT PARAPLEGIC CENTER PESHAWAR, PAKISTAN. KHYBER MEDICAL UNIVERSITY JOURNAL, 11(2). https://doi.org/10.35845/kmuj.2019.18441

Abstract

OBJECTIVE: to determine mortality and its associated factors in patients with spinal cord injuries (SCI), presenting to Paraplegic Center Peshawar, Pakistan.

METHODS: In this retrospective study, clinical records of SCI patients, admitted to Paraplegic Center from January 2011 to March 2017 were evaluated. SCI patients who died during this period, irrespective of their age, gender, duration of SCI and number of readmissions were included in study. Demographic information, clinical characteristic and complications in eligible patients were recorded and analyzed.

RESULTS: Out of 62 patients, 46 (74.2%) were males. Mean age of patients was 41.7±17.3 years. Twenty-two (35.5%) patients aged ≤30 years & 20 (32%) patients aged >50 years. The most common cause of SCIs was fall from height (n=23, 37.1%), followed by road traffic accident (n=17, 27.4%) and firearm injury (n=11, 17.7%). About 51.6% of patients (n=32) had complete thoracic paraplegia, 30.6% (n=19) had complete cervical tetraplegia and 8.1% (n=5) had incomplete cervical tetraplegia. Complications and co-morbid conditions included pressure ulcers (n=53; 85.5%), limb fractures (n=7 11.3%), deep venous thrombosis (n=3; 4.8%),   hepatitis (n=2; 3.2%) and injury to brachial plexus (n=1; 1.6%). Twenty-two (35.5%) patients underwent spine fixation surgery while forty (64.5%) patients were managed conservatively. Majority of the patients (n=51, 82.3%) died within the first year of SCI.

CONCLUSION: Relatively younger patients were predominant and complete thoracic paraplegia was the commonest SCI level. Presence of pressure ulcers, limb fractures and deep venous thrombosis in patients with SCI were major contributing factors to morbidity leading to mortality in our patients.

https://doi.org/10.35845/kmuj.2019.18441
PDF

References

Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006;87(8):1079-85. DOI:10.1016/j.apmr.2006.04.022.

Krause JS, Carter RE, Pickelsimer EE, Wilson D. A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil 2008;89(8):1482-91. DOI:10.1016/j.apmr.2007.11.062.

Darain H, Arsh A, Zeb A, Ilyas SM, Muhammad D, Khan MN. Epidemiology, clinical features and consequences of spinal cord injury in children. J Coll Physicians Surg Pak 2018;28(7):532-5. DOI: 10.29271/jcpsp.2018.07.532.

O’Connor PJ. Survival after spinal cord injury in Australia. Arch Phys Med Rehabil 2005; 86(1):37-47. DOI:10.1016/j.apmr.2004.03.018.

Thietje R, Pouw M, Schulz A, Kienast B, Hirschfeld S. Mortality in patients with traumatic spinal cord injury: descriptive analysis of 62 deceased subjects. J Spinal Cord Med 2011;34(4):482-7. DOI:10.1179/2045772311Y.0000000022.

Yeo JD, Walsh J, Rutkowski S, Soden R, Craven M, Middleton J. Mortality following spinal cord injury. Spinal Cord 1998;36(5):329-36. DOI: 10.1038/sj.sc.3100628.

Lidal IB, Snekkevik H, Aamodt G, Hjeltnes N, Stanghelle JK, Biering-Sørensen F. Mortality after spinal cord injury in Norway. J Rehabil Med 2007;39(2):145-51. DOI:10.2340/16501977-0017.

Frankel H, Coll J, Charlifue S, Whiteneck G, Gardner B, Jamous M, et al. Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord 1998;36(4):266-74. DOI:10.1038/sj.sc.3100638.

Hagen EM, Lie SA, Rekand T, Gilhus NE, Gronning M. Mortality after traumatic spinal cord injury: 50 years of follow-up. J Neurol Neurosurg Psychiatry 2010;81(4):368-73. DOI:10.1136/jnnp.2009.178798.

Oderud T. Surviving spinal cord injury in low income countries. Afr J Disabil 2014;3(2):80-9. DOI:10.4102/ajod.v3i2.80.

Hoque MF, Grangeon C, Reed K. Spinal cord lesions in Bangladesh: an epidemiological study 1994–1995. Spinal Cord 1999;37(12):858-61.DOI: 10.1038/sj.sc.3100938.

Levy L, Makarawo S, Madzivire D, Bhebhe E, Verbeek N, Parry O. Problems, struggles and some success with spinal cord injury in Zimbabwe. Spinal Cord 1998;36(3):213-8. DOI:10.1038/sj.sc.3100574.

Gosselin R, Coppotelli C. A follow-up study of patients with spinal cord injury in Sierra Leone. Int Orthop 2005;29(5):330-2. DOI: 10.1007/s00264-005-0665-3.

Michael J, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80(11):1411-9. DOI: 10.1016/S0003-9993(99)90252-6.

Arsh A, Darain H, Ilyas SM. Epidemiology and prevalence of deep venous thrombosis in patients with spinal cord injury. Pak J Neurolog Sci 2016;11(4):22-25.

Arsh A, Darain H, Ilyas SM, Zeb A. Prevelacne of pressure ulcers in patients with spinal cord injury; a retrospective study. Pak J Neurolog Sci 2012;11(4):16-21.

Rathore MFA, Hanif S, Farooq F, Ahmad N, Mansoor SN. Traumatic spinal cord injuries at a tertiary care rehabilitation institute in Pakistan. J Pak Med Assoc 2008;58(2):53-7.

Arsh A, Arsh A, Darain H, Ilyas SM, Zeb A. Consequences of traumatic spinal cord injury during pregnancy in Pakistan. Spinal Cord Ser Cases 2017;3:17041. DOI: 10.1038/scsandc.2017.41.

Masood Z, Wardug GM, Ashraf J. Spinal Injuries: Experience of a local neurosurgical centre. Pak J Med Sci 2008;24(3):368-71.

Setel PW, Whiting DR, Hemed Y, Chandramohan D, Wolfson LJ, Alberti K, et al. Validity of verbal autopsy procedures for determining cause of death in Tanzania. Trop Med Int Health 2006;11(5):681-96. DOI: 10.1111/j.1365-3156.2006.01603.x.

Tauqir SF, Mirza S, Gul S, Ghaffar H, Zafar A. Complications in patients with spinal cord injuries sustained in an earthquake in Northern Pakistan. J Spinal Cord Med 2007; 30:373-7. DOI:10.1080/10790268.2007.11753955.

Rathore M, Rashid P, Butt A, Malik A, Gill Z, Haig AJ. Epidemiology of spinal cord injuries in the 2005 Pakistan earthquake. Spinal Cord 2007;45(10):658-63. DOI: 10.1038/sj.sc.3102023. Epub 2007 Jan 16.

License