Patients with traumatic spinal injuries treated in a low- and middle-income country: what happens after discharge?

Abstract

Objective: Traumatic spinal injuries (TSIs) represent significant global health challenges, particularly in low- and middle-income countries (LMICs). In a cohort of patients with TSI from a major East African center, the authors sought to address long-term outcomes after hospital discharge through the following objectives: 1) describe who was successfully contacted after hospital discharge, 2) report posthospital complications, and 3) assess predictors of successful posthospital contact and posthospital complications.

Methods: An institutional TSI registry of patients treated from 2016 to 2021 was the source of patients and contact methods. Telephone calls were made to the primary telephone number between June 2022 and May 2023, and a subjective neurological assessment was performed using a questionnaire. The study outcomes were successful posthospital contact and postdischarge complications. Predictors of each outcome were assessed through univariable and multivariable logistic regression.

Results: Of the 466 TSI patients treated from 2016 to 2021, 40.6% were successfully contacted at a median follow-up period of 29 months. Their median age was 34 years, and most patients were male (n = 400, 85.8%). Among those contacted, 84.8% experienced postdischarge complications, including muscle spasticity (n = 89, 61.4%), pressure ulcers (n = 52, 35.9%), and death (n = 39, 21.2%). Most patients reported a perceived improvement in their neurological status. Key factors predicting successful contact included undergoing surgery, involvement in road traffic accidents, and more recent hospital admission dates following TSI (2019-2021). Employment postinjury was associated with fewer complications (OR 0.20, 95% CI 0.04-0.76; p = 0.029). American Spinal Injury Association Impairment Scale (AIS) grade A at discharge was associated with a significantly increased mortality risk compared with AIS grades B-E (OR 15.58, 95% CI 5.80-50.46; p < 0.001).

Conclusions: This is one of few studies to report on posthospital follow-up using telephone contact for TSI in an LMIC. Among the contactable patients, there were high rates of morbidity and mortality and low rates of employment, showing the considerable medical, social, and economic impact of TSI in this young population and the need for rehabilitation and support services postdischarge.