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Does the Mechanism of Injury Correlate with the Outcome of Spinal Trauma? An Observational Cohort Study Conducted in Tanzania

Friday, May 3, 2024

    Presenting Author(s)

  • Chibuikem A. Ikwuegubenyi, MD

    Research Fellow
    Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York

    • Co-Author(s)

  • BC

    Beverly Cheserem, MD

    Neurosurgeon
    Neurosurgery Unit, Aga Khan University Hospital, Nairobi, Kenya;, United States

  • Roger Hartl, MD

    Director of Spinal Surgery
    Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine
    New York, NY, US

  • AL

    Albert Lazaro, MD

    Resident
    Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States

  • AL

    Andreas Leidinger, MD

    Neurosurgeon
    Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, United States

  • HM

    Halinder S. Mangat, MD

    Physician
    Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA., United States

  • HS

    Hamisi K. Shabani, MD; PhD

    Neurosurgeon
    Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania, United States

  • FW

    Francois Waterkeyn, MD

    Neurosurgeon
    Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium, United States

  • JW

    Julie Woodfield, MD; PhD

    Neurosurgeon
    Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, United States

  • Scott L. Zuckerman, MD, MPH (he/him/his)

    Assistant Professor of Neurological Surgery
    Vanderbilt University Medical Center
    Nashville, Tennessee, United States

Introduction: Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI.

Methods: A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement and deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses.

Results: A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p< 0.01) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p< 0.01). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries.

Conclusion : In urban Tanzania, RTA-related TSI has similar outcomes to non-RTA-related TSI. Mortality was related only to sustaining complete cervical injuries. As rates of TSI and outcomes are similar between RTAs and other mechanisms, primary prevention should equally prioritize non-RTA-related spine trauma.