Neglected traumatic spinal cord injuries: causes, consequences and outcomes in an Indian setting

Abstract

Study design: Retrospective analysis.

Objectives: To study the causes, consequences and outcomes of neglected traumatic spinal cord injuries (Neg-TSCIs) admitted at the center.

Setting: Tertiary level spinal injury center, India.

Methods: Information was collected from case sheets of 61 persons with Neg-TSCI for whom comprehensive management could not be initiated till at least 4 weeks after the injury and another 62 persons for whom treatment was initiated within 2 days of injury.

Results: The range of duration of neglect was 4-676 weeks. Rehabilitation had not been initiated in 93.4% of Neg-TSCI patients. There was a statistically significant poorer functional outcome in Neg-TSCI.

Conclusions: Neg-TSCIs are injuries in which comprehensive management is not initiated in a timely fashion. Lack of/inadequate awareness was the most common specific cause. Neg-TSCIs add to the complexity of vertebral lesion management, physical and psychosocial rehabilitation. They have a much higher incidence of complications, which are more severe and difficult to manage. They require a longer hospitalization, add to the costs and adversely affect functional outcomes. The findings differ from that of the few studies done in developed countries in that premature discharge in first admission with inadequate or no rehabilitation was the major general cause of neglect rather than overlooked diagnosis and that there was generally an unsupervised period at home before admission to the definitive center. The study brings out the importance of avoiding any delays in starting comprehensive management after spinal injury and taking treatment in a definitive spinal injury center.