Complications in Patients with Spinal Cord Injuries Sustained in an Earthquake in Northern Pakistan

ABSTRACT

Background: Spinal cord injury (SCI) is devastating trauma suffered by many of the victims of an earthquake that struck Northern Pakistan on October 8, 2005. It rendered approximately 600 patients paraplegic, which is the highest number ever reported in any disaster. This study was conducted to evaluate the risk of complications. Methods: The cross-sectional restrospective study covering a 2-month perido was conducted on 194 patients admitted to the surgical/neurosugical wards of Rawalpindi Medical College and allied hospitals (Holy Family Hospital, Rawalpindi General Hospital, and District Headquarter Hospital) and Melody Relief and Rehabilitation Center, Islamabad. Results: The male-to-male ratio was approximately 13 (n=50 [26%] and n=144 [74%], respectivily). The majority (78% [ n=151]) were 16 to 39 years of age; 62% (n=120) had lumbar-injuries, 25% (n=48) had thoracic-level-injuries, 9% (n=18) had thoracolumbar-level injuries, and a few had cervical - or sacral-level-injuries. Forty six percent (n=90) had American Spinal Injury Association type A injuries; 4% (n=8) were graded B, 11% (n=21) were graded C, 95 (n=18) were graded D, and 14% (n=27) were graded E. Twenty percent (n=39) developed pressure ulcers, of which 38% (n=15) had grade, 1, 36% (n=14) had grade 2, 23% (n=29) had grade 3, and 3% (n=1) had grade 4. All patients developed urinary tract infections; 15% (n=30) had bowel complaints; 2% (n=3) developed deep-vein thrombosis (1 died of pulmonary embolism); and 0.05% (n=1) developed wound infection. Conclusion: Awareness of potential complications in patients with paraplegia is essential to care planning in the disaster setting. The priorities include skin, bowel, and bladder care and provision of prophylactic heparin. SCI post-disaster care requires comprehensive long-term planning. (AU)