Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-00334-w · Published: August 24, 2020

Spinal Cord Injury Healthcare Public Health

Simple Explanation

This study investigated the long-term outcomes for people with traumatic spinal cord injuries (TSCI) in Cape Town, South Africa, focusing on mortality and the prevalence of secondary medical complications four years after the injury. The researchers followed a group of individuals who sustained TSCI between 2013 and 2014, collecting data on their survival status and any medical issues they experienced. The findings highlight significant challenges faced by individuals with TSCI, including a high mortality rate and a substantial burden of secondary complications, emphasizing the need for improved prevention and management strategies.

Study Duration

4 Years

Participants

145 initially, 87 accounted for at follow-up

Evidence Level

Prospective, regional, population-based study

Key Findings

1
Almost one-quarter of persons with TSCI have died 4 years after injury.
2
Secondary complications were found to be highly prevalent at 4 years after injury, with pain being the most problematic.
3
Completeness of injury and aetiology, speciﬁcally falls, were signiﬁcant non-modiﬁable risk indicators for mortality

Research Summary

This study determined the mortality rate, as well as reasons for death, 4 years after injury and determine the point prevalence of secondary medical complications of those alive after 4 years, living in the City of Cape Town, South Africa. The mortality rate was 24% (21 out of 87 included) 4 years post injury. The signiﬁcant non-modiﬁable protective factors related to mortality were persons with incomplete injuries and those having transport-related injuries. Of the 55 persons who were alive and completed the survey, 89% (n = 48) of persons had at least one medical compli-cation, while the most common secondary medical complications at 4 years after injury were pain (n = 44, 80%), muscle spasms (n = 42, 76%), sleeping problems (n = 31, 56%), and autonomic dysreﬂexia (n = 29, 53%).

Practical Implications

Prevention Programs

The information from this study could be used to develop secondary complications prevention programmes to reduce premature deaths.

Targeted Management

Those with complete injuries should be targeted in the management of their injuries both in terms of survival and recovery.

Information System Development

The department of health should invest in developing an information system speciﬁcally for SCI in order to track and observe trends, outcomes and ensure capacity of health care services, which could further lead to better coordinated and integrated care plans for persons with SCI.

Study Limitations

1
The high loss to follow-up (40%) could have severely underestimated the mortality rate.
2
No physical assessment of functioning and deﬁcits was performed at 4 years of injury
3
The lack of follow-up was precipitated by the lack of safety, which was a major risk, as many of the areas the respondents emanated from were in the Cape Flats of the Western Cape, affected by high violence/crime-related activities.

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