Clinico-epidemiological study of spinal injuries in a predominantly rural population of eastern Nepal: A 10 years′ analysis

Background: A clinico-epidemiological study helps to plan future preventive measures and management strategies for spinal trauma. This is a 10 years′ retrospective review of spinal-injury patients treated at a tertiary health center in the eastern of Nepal to determine clinico-epidemiological aspects of spinal-injury patients in a predominantly rural population of eastern Nepal. Materials and Methods : All medical record files of patients with spinal injury from 1996 to 2005 in the Medical Record Section of BPKIHS (B. P. Koirala Institute of Health Sciences) were studied. The preformed pro forma consisting age, sex, place of living, mode of injury, hospital stay level of injury, site of injury, associated injury, Frankel grading of neural deficit and treatment modality was filled from the record files of patients. These parameters were entered in Excel 8 and analyzed by EPI INFO 2002. Details of 896 patients of spinal injury were recorded in the 10-year period of review. Results : 684 (76.35%) male and 212 (23.66%) female patients with mean age of 41.74 ± 16.53 years and 38.56 ± 15.86 years respectively were studied. Two hundred forty-two (27%) patients were from hilly districts of eastern Nepal. Fall from height [in 350 (39%) patients] was the commonest mode of spinal injury. Six hundred thirty-six (71%) patients presented with a neurological deficit. Seven hundred thirty-three (85%) patients were treated conservatively, compared to 163 (15%) surgically treated patients. One hundred forty-six (22%) patients were treated with operative interventions in the last five years. Conclusion : The study shows that the most vulnerable group for spine injury was the group of patients of productive age with late presentation (i.e., injury hospital duration - 41.64 ± 54.24 hours) without proper pre-hospital management. The treatment modalities have changed (from conservative to surgical) in this part of the world. These specific observations help us in further planning for preventive measures and management in our setting.