New Study: Management + Outcomes of Spinal trauma in East Africa

Outcome data and studies are constantly being looked at to try and improve the management and outcome of spinal trauma in high income countries like the UK. We know, for example, that the ‘time’ from injury to treatment is one of the key factors. You may have heard of the “golden hour”? The golden hour is the period of time, following a traumatic injury, when medical and surgical intervention will most likely prevent death.

So just having a read a report about a study that is looking at the management and outcomes of spinal trauma in Tanzania I was shocked at some of the results. I was not surprised to read that there is a lack of referral/trauma hospitals in Tanzania and that the decisions to perform surgery on trauma patients are influenced by the availability of surgical implants, cost and insurance factors. However I was shocked that the average time to admission (ie. how long after the accident a patient with spinal trauma and neurological deficit got to an appropriate trauma unit) was 5.9 days!  The average distance travelled was 278km! The orthopaedic hospital in Tanzania is the Muhimbili Orthopaedic Institute in Dar es Salem.

The majority of trauma was due to falls from heights and motor vehicle accidents and was predominantly in young men. After travelling all that way to the trauma hospital, only 40% of these patients were actually operated on and if they were operated on, on average it was 33.2 days after their accident. Furthermore, the report suggested that the patients who were prioritised for surgery were usually the ones with the most neurological deficit and not the ones who could probably benefit most from surgery.

Despite the limitations of this study, the conclusion was that “Education and more collaboration with surgical societies and academic groups dedicated to global surgery are also necessary.” But it recognised that economic factors play the biggest role and these are out of the spinal community’s control.