Abstract
Study design:
Descriptive study.
Objectives:
To describe the epidemiological features of spinal cord injury (SCI) following the 2015 earthquakes in Nepal.
Setting:
Spinal Injury Rehabilitation Centre, Kavre, Nepal.
Methods:
Data were collected from the medical records of all earthquake-related patients seen from 25 April 2015 through to 16 June 2016. Data collected included patient demographics, mechanism of injury, initial medical treatment, neurological assessment, complications, neurological/functional outcomes and length of stay.
Results:
Data from 117 earthquake-related SCI patients were evaluated, with a female-to-male ratio of 1.3:1. In total, 108 patients (92%) sustained vertebral fracture and/or dislocation. Seventy-seven patients had undergone surgical fixation. The majority of patients (81%) presented with paraplegia, of whom most (60%) were incomplete. Thirty-eight (33%) patients had documented pressure ulcers upon admission; six (5%) patients developed new pressure ulcers during their rehabilitation stay. Urinary tract infection was seen in 34 (29%) patients. Seven (6%) patients were diagnosed with deep vein thrombosis. One patient developed clinically significant heterotopic ossification. Significant improvements were seen in patients’ functional outcomes before discharge. Two deaths occurred in this patient population.
Conclusions:
The Nepal earthquakes resulted in a significant number of SCIs, the majority occurring in women. Incomplete paraplegia was the most common presentation. Pressure ulcer, the most frequent complication, primarily occurred before rehabilitation admission. Continued efforts focused on comprehensive planning, and preparedness for SCI-specific interdisciplinary care following earthquakes, particularly in resource-limited settings, is critical to ensuring survival, preventing complications and optimizing functional outcomes in this patient population.
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Acknowledgements
We are extremely grateful for the support of many during the post-disaster period, including more than 60 international volunteers (both in person and via telephone/internet). We greatly appreciate organizational support from Asia Spinal Cord Network, Department for International Development, Direct Relief, Handicap International, International Spinal Cord Society, Médecins San Frontières, Nepal Institute of Medicine, Save the Children, Spinal Injury Sangha Nepal and the World Health Organization. Innumerable local and international donors also helped make this work possible. Particular thanks to Dr Jim Malec, Mr Stephen Muldoon, Ms. Fiona Stephenson, Dr Claire Weeks and Dr Peter Wing. Finally, we acknowledge our Nepali colleagues throughout the country who worked tirelessly to provide excellent care for thousands of patients and who recognized the need for urgent SCI-specific rehabilitation.
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Groves, C., Poudel, M., Baniya, M. et al. Descriptive study of earthquake-related spinal cord injury in Nepal. Spinal Cord 55, 705–710 (2017). https://doi.org/10.1038/sc.2017.25
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DOI: https://doi.org/10.1038/sc.2017.25
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