Assistant Professor of Neurosurgery and Orthopaedics Vanderbilt University Medical Center Nashville, Tennessee, United States
Disclosure(s):
Scott L. Zuckerman, MD, MPH: National Football League: Consultant (Ongoing)
Introduction: Previous research has shown that patients with traumatic spine injuries in low-middle income countries (LMIC) undergo significant delays to surgery due to cost-prohibitive implants. At a major East African referral center, we sought to prospectively implement a Spine Trauma Protocol to evaluate the primary outcome of time from admission to surgery and secondary outcomes of neurologic improvement and complications.
Methods: A prospective, pre-post intervention study was conducted at a major East African hospital to implement a Spine Trauma Protocol from 10/2016-12/2019: pre-protocol (33-months) vs. post-protocol (6-months). All spine trauma patients were included. The Spine Trauma Protocol recommended surgery within ≤72 hours and provided spinal implants free of cost. The primary outcome was days from admission to surgery. Secondary outcomes included: neurologic improvement and complications. Pre-post comparisons were performed with parametric/non-parametric tests.
Results: Among 341 patients, 301 pre-protocol patients were compared to 40 post-protocol patients. 141/301 (47·0%) underwent surgery in the pre-protocol phase compared to 37/40 (92·5%) in the post-protocol phase (p < 0·001). The primary outcome of days to surgery was significantly decreased in the post-protocol phase (25·9±18·5 vs. 2·4±2·3, < 0·001). A higher rate of neurologic improvement was seen in the post-protocol phase (13·8% vs. 27·5%, p=0·024). Surprisingly, higher mortality was seen in patients undergoing surgery during the post-protocol phase (5·0% vs. 27·0%, p< 0·001). All 10 patients that died had complete neurologic injuries and 9/10 (90.0%) were cervical.
Conclusion : A prospective Spine Trauma Protocol at a tertiary East African hospital providing free spinal implants led to faster time to surgery and neurologic improvement. However, an increase in mortality was seen, mainly affecting patients with complete cervical spinal cord injuries. The results of this study provide many learning opportunities for spine trauma care worldwide.
