Abstract
Study design
Descriptive study.
Objectives
To describe patient handling at injury site, number of healthcare centre transfers to reach tertiary trauma centre, modes of transportation, and time from injury to reaching tertiary trauma centres among individuals with acute traumatic spinal cord injury (tSCI).
Setting
Acute SCI rehabilitation centre, Nepal.
Methods
All individuals with new tSCI admitted for rehabilitation over period of 1 year were eligible for enrolment. Following written, informed consent, enroled individuals participated in structured one-on-one interview. Data collected included demographics, injury details, pre-hospital handling techniques, and transportation specifics to tertiary trauma centre.
Results
In total, 211 individuals were enroled in the study. Eight (4%) individuals were assisted by first responders or traffic police, with majority (n = 203, 96%) assisted by untrained individuals. One was transferred from injury site using spinal motion restriction measures. Half were transported exclusively by ambulance while others used combinations of transportation. Six (3.4%) individuals were cared for by trained medical person during transport. Half required two or more hospital transfers prior to reaching a tertiary trauma centre. In total, 98 individuals required >24 h to reach the tertiary trauma centre.
Conclusions
Individuals sustaining a tSCI in Nepal often experience improper handling, multiple hospital transfers, and prolonged time to reach tertiary trauma centres following acute tSCI. Further expanding emergency medical response systems throughout the country, training and equipping first responders in spinal motion restriction techniques, and establishing clear referral pathways for individuals with suspected tSCI are warranted. Development in these specific areas may reduce morbidity and mortality following acute tSCI.
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Data availability
The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.
References
Mock C, Lormand JD, Goosen J, Joshipura M, Peden M. Guidelines for essential trauma care. Geneva: World Health Organization; 2004.
Chhabra H (editor). ISCoS textbook on comprehensive management of spinal cord injuries. 1st ed. New Delhi: Wolters Kluwer; 2015.
Kornhall D, Jørgensen J, Brommeland T, Hyldmo P, Asbjørnsen H, Dolven T, et al. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med. 2017;25:1–11.
Maschmann C, Jeppesen E, Rubin M, Barfod C. New clinical guidelines on the spinal stabilisation of adult trauma patients—consensus and evidence based. Scand J Trauma Resusc Emerg Med. 2019;27:1–10. https://doi.org/10.1186/s13049-019-0655-x.
Ahn H, Singh J, Nathens A, MacDonald R, Travers A, Tallon J, et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma. 2011;28:1341–61.
Bajracharya S, Singh M, Singh G, Shrestha B. Clinico-epidemiological study of spinal injuries in a predominantly rural population of eastern Nepal: a 10 years’ analysis. Indian J Orthop. 2007;41:286.
Dhakal G, Paudel S, Dhungana S, Gurung G, Kawaguchi Y. Epidemiological characteristics of dorsal and lumbar spine trauma presenting to a Trauma Hospital in Kathmandu, Nepal: formulation of a national spine policy. Spine Surg Relat Res. 2018;2:249–52.
Banstola A, Smart G, Raut R, Ghimire K, Pant P, Joshi P, et al. State of post-injury first response systems in Nepal—a nationwide survey. Front Public Health. 2021;9:1–7.
Acharya R, Badhu A, Shah T, Shrestha S. Availability of life support equipment and its utilization by ambulance drivers. J Nepal Health Res Counc. 2017;15:182–6.
Shrestha SK, Koirala K, Amatya B. Patient’s mode of transportation presented in the emergency department of a tertiary care centre, Kavre, Nepal. Kathmandu Univ Med J. 2018;16:39–42.
Bhandari D, Yadav N. Developing an integrated emergency medical services in a low-income country like Nepal: a concept paper. Int J Emerg Med. 2020;13:1–5.
Government of Nepal Ministry of Health. Nepal Health Sector Strategy Implementation Plan 2016–2021. 2017.
Acknowledgements
The physiotherapists of Physiotherapy Department of SIRC have assisted in collecting the demographic data of individuals with SCI.
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Contributions
SS was responsible for constructing the questionnaire, collecting feedback from expertise, submission for ethical approval, carrying out interview, data entry, statistical analysis, interpreting results and manuscript writing. KS was responsible for constructing the questionnaire, collecting feedback from expertise, data entry, statistical analysis and handling technical issues. CCG contributed to study design, data analysis, and manuscript preparation.
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The authors declare no competing interests.
Ethical approval
All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. SIRC’s research committee and the Nepal Health Research Council approved the study (Reg.no 235/019).
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Shrestha, S., Shrestha, K. & Groves, C.C. Patient handling and transportation from site of injury to tertiary trauma centres in Nepal following acute traumatic spinal cord injury: a descriptive study. Spinal Cord Ser Cases 8, 79 (2022). https://doi.org/10.1038/s41394-022-00545-3
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DOI: https://doi.org/10.1038/s41394-022-00545-3
