Assessment of physicians' knowledge of Glasgow coma score.

BACKGROUND: Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological services are not conversant with this life-saving tool. OBJECTIVE: The objective of this study was to assess the level of knowledge of GCS among physicians practicing in a tertiary institution in South-East Nigeria, and to evaluate the call for a new and simpler scoring system. MATERIALS AND METHODS: This study was carried out using the instrument of a structured-questionnaire in Nnamdi Azikiwe University Teaching Hospital Nnewi, a federal government tertiary health institution in South-East Zone of Nigeria, which is a 350-bed facility employing about 550 medical doctors of different cadres. RESULTS: A total of 139 questionnaires were distributed to the doctors practicing in the institution who consented to participating in the study. The questionnaires were completed at the point of their administration and completed questionnaires were retrieved on the spot, and data were collated, and analyzed with the Statistical Package for Social Sciences, SPSS version 17.0. Statistical significance was calculated with the chi square, P ≤ 0.5. The modal age group was 20-30 years 66 (48%), and most were resident doctors 99 (66.2%). One week prior to the questionnaire distribution, 56 (42.1%) had been actively involved in emergency care of patients, and 41 (30%) could not recall what GCS stood for. Medical and house officers showed a better knowledge of GCS. CONCLUSION: There was a poor knowledge of GCS among a good number of physicians practicing in our setting and hence, continuing medical education on GCS is strongly advocated.

Outcome of spinal cord injuries managed in a centre without modern imaging facilities.

BACKGROUND: The paucity of published reports from West Africa on the outcome of spinal cord injuries (SCI) reflects the limitations of the developing health care delivery system in this part of the world. OBJECTIVE: To review the outcome of the spinal cord injuries managed in our centre and relate same to those of published reports. METHODS: We conducted a prospective study by utilizing a structured proforma on all SCI cases admitted to and managed in our service from April 21, 2006 to April 20, 2008. The collated data were then analyzed and compared to the literature. RESULTS: Spinal injury (neural and non-neural) was diagnosed in 62 (7.5%) of 826 total consultations in the two-year period under study. Thirty five (56.5%) of them were less than 40 years with fewer cases at the extremes of age, and most 47 (76%) were males. Forty nine (79%) had neural injuries of which the majority (94%) involved the spinal cord. Treatment was nonoperative in all cases, and all those with complete cord injury remained without neurological recovery, whereas 91% of cases of incomplete injuries made varying degrees of recovery. Mortality from the cord injuries was 13 (28.3%), and all were in the cervical region. Twenty (32.3%) were followed up in the outpatient clinic for a mean period of 13.7 weeks (range 1.4 to 63.4 weeks) following discharge. CONCLUSION: Our findings support the reports that cases of incomplete cord injury make neurological recovery, while those of complete injury do not. Our mortality rate of 28.3% compares closely with the mortality rates from other local series.

Patterns of Spinal Injury in a New Neurosurgical Centre: A 2-Year Prospective Study

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Road traffic accident is the main aetiologic factor; affecting mostly the male gender in the 15 - 40-year age group. The aim of this study was to establish our local hospital patterns of spinal injury and compare them with published reports. Methods and Patients: A prospective study of all spinal injury patients treated in our service in the two-year period; April 21; 2006 - April 20; 2008 was undertaken. Data collection was done using a structured proforma from the time of admission into our service to the time of discharge; and subsequent follow-up in the few cases that kept to their appointment. Data was then collated and simple data analysis done. Results: Spinal injury was diagnosed in 62 of our 826 patients; mostly males; aged 15-40years 28 (45.2); and road traffic accident was the main aetiologic factor with an unusually high case incidence from motorcycles. There were neurological deficits in 49(79) and cervical cord injuries were the most common. Evaluation of the injuries was mostly with plain radiography; and treatment was non-operative in all cases. omplete cord injuries remained without improvement; and complications were mostly pressure ulcers; with no incident of deep venous thrombosis. Mortality was 13(21). Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete injuries contrary to other previous reports; and the case incidence from motorcycles was remarkably high