Vinod Kumar B. P1
BACKGROUND
Craniospinal injuries are most important cause of mortality and long-term morbidity. There are no studies in our setup to develop a protocol for management of craniospinal injury victims, their transportation, risk factors for severity and factors that determining the prognosis, hence this study. Even now, it is important that the ‘108’ ambulance services was not operating in our place, which had given all the support of transportation in a scientific manner. In 1999-2000, there were 37,072 accidents in Kerala; of this, 9184 came to medical college, Trivandrum; 208 (18%) out of 1111 craniospinal injuries died. The primary goal of transportation is to transfer a patient to an emergency room with all system stabilised in order to enhance the potential for maximal neurological recovery and to avoid any additional secondary injury.
MATERIALS AND METHODS
Is delay in reaching a tertiary care centre, a determinant of bad outcome as measured by case fatality and paralysis in spinal injuries?.
Setting- Tertiary care centre, Government Medical College Hospital, Thiruvananthapuram.
Sample size- 76 cases and 76 controls.
Data collection- Researcher administered structured questionnaire.
Statistical methods- Using EPI6 and SPSS.
RESULTS
Average delay suffered by a severe case was 22.40 hrs. The average age of a severe victim was 43 yrs. and the average distance that a severe spinal injury victim travelled was 54 kms.
Delay more than 3.5 hrs. had an odds ratio of 8.94 (95%, CI: 3.99-2028).
Delay- (Odds ratio): 0-2 hrs. (1); 2.001-4 (7.24); 4.001-6 (18.55); 6.0001-16:(11.96); >16 hrs. (43.28).
Distance more than or equal to 41 kms had OR of 2.095 (1.01-4.36).
Distance- (Odds ratio); 0=<40 (1) -=>41; (2.28).
Age- =<20; (1) 21-40:(1.53) =>41; (2.28).
Cervical spine injury victims had an odds ratio of 5.08 (95%, CI: 2.54-10.13).
Employed persons are at higher odds of 4.40 (95%, CI: 1.59-12.12).
Manual labourers and tree climbing had OR=3.08 (95%, CI: 0.81-11.67).
CONCLUSION
The major aetiological factors found significant to contract a bad outcome following spinal injuries were- 1. Delay in seeking treatment. 2. Number of shifting after accident. 3. Distance from the site of accident to the treatment center. 4. The nature of injury in the form of cervical spine injury. 5. The occupation of accident victims. 6. The mechanism of injury like RTA, fall from height, etc., age, alcohol habits, gender and co-morbid conditions not came forward as significant risk factors.
