Patterns and Determinants of Outcomes in Cervical Spine Injury Patients: A Retrospective Study at AaBET Hospital, Addis Ababa, Ethiopia

Abstract

A cervical spinal cord injury is a tragic occurrence for the sufferer and their loved ones. Because so many resources are needed to manage the patient during both the acute and rehabilitative stages, it has a significant impact on society and it is mainly related to cervical spine fractures and the most frequent kind of spinal fractures are those to the cervical spine. Automobile accidents, followed by diving into shallow water, firearm injuries, and sports activities are common causes of cervical spine injury. In developing countries like Ethiopia, little is known about the prevalence of cervical spinal injuries. An understanding of the prevalence of spinal injury is fundamental to developing possible preventive strategies and improving our primary trauma care. Assessing the pattern, outcome, and associated factors of patients with cervical spine injury who have visited AaBET Hospital from January 1, 2018 to November 30, 2023 is the primary objective of this study. Institution-based cross-sectional study was conducted at AaBET Hospital, Addis Ababa, Ethiopia. The study included patients who presented to the emergency department with a diagnosis of cervical spine injury from January 1, 2018, to November 30, 2023. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine associations between dependent and independent variables. A p-value <0.05 was considered statistically significant. A total data of 149 patients were analyzed, with an average age of 36.3 ± 14.9 years (ranges 9-85 years) and the male-to-female ratio was 2.9:1. Road traffic accident occurs in 49.7% of patients as a mechanism of injury followed by falling down accident (39.6%) of patients. Seventy-eight (52.3%) patients sustained with a total of 114 associated injuries (ASOI). Head injury was the commonly associated injury followed by chest and extremity injury. The most frequently injured cervical vertebra was C7 followed by C6 and T1. 68.5% of the patients have multilevel injuries. 33.6% of patients have neurological impairment ASIA class A followed by ASIA class E (29.5%). The overall hospital mortality is 7.4%. The level of cervical spine injury, the ASIA class of the patient, and the presence of associated injury were strongly associated with mortality. The mean ± SD length of hospital stay was 13.6 ± 16.4 days. And 30.2% of patients have prolonged lengths of hospital stay (PLOS). Neurosurgical intervention and the presence of associated injury have been significantly associated with PLOS. This study showed the common mechanism was RTA and C7 was the common injury level. C3 injury level, ASIA A neurologic deficit, and having associated injury were associated with mortality. Undergoing neurosurgical intervention and the presence of associated injury were associated with prolonged length of hospital stay (PLOS).