An evaluation of the initial management of patients with cervical spine injury in mulago hospital.

Abstract

CSI occurs in 5-10% of major trauma patients. Interventions instituted immediately following injury are the greatest determinants of outcome. Cervical spine stabilization immediately on suspicion of CSI, appropriate resuscitation, evaluation and early reduction were indicated have been shown to reduce mordacity and mortality. Use of steroids is controversial. To help improve the care of CSI patients in mulago hospital, an evaluation of current practice and recommendation of corrective measures where needed was done. In this cross-sectional descriptive study, 105 consenting patients with features suggestive of CSI who met the inclusion criteria, admitted to mulago hospital during the study period were recruited. Timing and modality of spine stabilization, resuscitation measures, steroid administration, clinical evaluation, radiological evaluation, diagnosis and attempt at reduction were recorded in a pre-tested questionnaire and analysed for appropriateness. Only 5(5%) patients had complete records of vital signs with the bulk – 78 (74%)-having incomplete records. 22(21%) had no records at all/. Of the 51 patients requiring different resuscitation measures only 2(4%) had complete records of resuscitation measures taken. 1 (6%) of the 17 patients requiring a definitive airway had one in place. 55(52%) patients got IV fluids but none of the 19 requiring aggressive IV fluid resuscitation received adequate fluids. Pain control was adequate in 27 (47%) of the patients who were able to give an assessment of the level of pain control. Only 28 (27%) patients got some form of cervical spine protection with the bulk getting improvised collars of unknown afficacy. Only 2 2%) had the recommended rigid cervical though this was not accompanied by protection of the rest of the spine pending its clearance. Clinical evaluation was suboptimal with 35 (33.5%) patients being evaluated for neck pain and cervical tenderness and 38 (36.2%) being evaluated for deficits referable to the cervical spine. Radiographs were obtained for only 29(28%) patients all getting AP and lateral views. Only 1 had an open mouth view x-ray taken. 17(59%) of the lateral view radiographs were considered inadequate. 76 (72.4%) patients had not been cleared in the first 24 hours of arrival in mulago. 9 (11.8%) died before their cervical spine was cleared. Of the 29 patients cleared radiologically, 17 (59%) were found to have lesions requiring skull traction. None of them got this instituted within the first 24 hours. No patient received asteroids. This study concluded that all aspects of the initial management of CSI were suboptimal. It recommended the retraining of emergency staff on the management of CSI, Provision of necessary materials/equipment and that a hospital protocol on the initial management of CSI be developed.