Care of New Traumatic SCI Patients in Jamaica

7/24/2019 Care of New Traumatic SCI Patients in Jamaica

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ACKNOWLEDGMENTS

Dr. Ian Neil, Consultant Orthopaedic Surgeon,Kingston Public ospital !Supplied data "rom the #$$%paper & Mortalit' (mong Spine In)ur' Patients in a

Tertiar' ospital in Jamaica*+

ecords o-ce and medical sta, Sir John /oldingehabilitation Centre


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M(JO 01(KN1SS1S

ecord storage and 2ualit' o" recording2uestionable and not standardi3ed e.g. !ICDs'stem o" disease classi4cation not used,

uncertainties 5ith diagnoses and de4nitions, 4eld5or6ers not trained No "ormal "unctional outcome s'stem is presentl'

in place

No national spinal registr' in place so onl' casesthat presented to the ehab ospital 5ererepresented


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BACKGROUND

Population #$$%7

8 million

One ehab Centre!8$ adult beds+

9arge number o"trauma cases

Population :%;p to :%?$@s mostl'Polio and non

traumatic disorders


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Sir John /olding ehabilitation Center !SJ/1st. :%;T1 SPIN1 T(>M(C(S1S

Patients admitted to KP ortho::#$$;E8::##$$?, mechanical spine

disorder 5ith or 5ithout neurologicalde4cit+.

This proided data "or the acute spinal

cord in)ured patients


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! KP (C>T1 C(1 #$$;E#$$?+Mechanism Total Dead Alive Mortality

risk

"rau#a $$% &' ' *.+

M- +% $ $ .0

1all! '* $ $%.

Other && 0 $' 0.$

"otal $$% &' ' *


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(C>T1 C(1 !#$$; F #$$?+Variables Male(%) Female(%) Total(%)

Sex *0.* $%.& ++

"y2e o3 !2inal 4ordin5ury

6oneBro7n8Se9uard

Cauda :9uina;ara2legia

Central 4ord !yndro#e"etra2legia

$0.+.+'.*$.*+.%&%.$

&+.*$.*'.+&+.*.&'.*

$.0+.*'.0$&.+.&+.%


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-ariable! Male () 1e#ale() "otal ()

Se=erity o3 >n5uryS> DS> CS> BS>

Other

$.%.0%.$'.'$.

$.%0.*+.+$$.&+.+

$*.%.&&.$.'$&.&

Co#2li4ation!6o 4o#2li4ation

One 4o#2li4ation"7o 4o#2li4ation

? three4o#2li4ation!

%*.

$+.+&.0.%

%&.'

.*$+.''.'

%.&

.&0..&

Di!2o!al

li=eDead

'$.+'.+

'$.**.&

'$.*.


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Mean age (yrs) 53.5 (males) 3.5 (!emales)

Mean ti#e to!2e4iali!t(day!)@

0.* day! . day!

Mean ti#e to!urgery (day!) %. $+.$

Mean


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COMP9IC(TIONS OA (C>T1 SCIP(TI1NTSComplications Mal Fmal

espirator' #= ##

Septicaemia = 8

>TI :; 8$

Decubitus >lcers :$ :G

(naemia ? :8

Others :?


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COMP9IC(TIONS OA (C>T1 SCIP(TI1NTSTa!l " Ca#ss o$ Dat% Amon& Spin In'#()

*atints

espirator' :G !8$.%H+

Sepsissepticaemia :? !8#.GH+

Pulmonar' 1mbolism ::!#$.$H+

Cardiac = !:$.%H+

Other 8 !;.;H+

Other causes Per"orated gastric ulcer, Massie upper /I bleed,Aluid and electrol'te imbalance


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(DMISSIONS TO 1(B C1NT1 !SJ/C+

Mechanism

"## "##5 "#$$ "#$"

"rau#a & %$ %' &+

M- *

1all! * ' + *

GS>

Stab

0

$+

&

&

+

$

"u#our $ + & +

Degenerati=e/other

$ ' %

C- % 0

"otal %' 0+ + %


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(DMISSIONS TO SJ/CCord

Syndro#e

$++% $++0 $+ $+$

"etra2legia %

;ara2legia $* $& &* $$

"i#e to Rehab


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"i#e to Rehabad#i!!ion 3ro#in5ury(Days)

"#$$ "#$" Total e!errals!rom &' (5")

'ost *rgery&' ("+)

&+ $ & $

&+ + $+ $+ '

+ * $' $&


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DISC(/1 P9(NNIN/

Begins 5ithin t5o 5ee6s o" eachadmission 5hen /oal Sheet meeting isheld

Is reie5ed 5ee6l' and ma' beaected b' special

needscircumstances


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0119C(I(C>ISITION>S1

No precise data

>suall' occurs a"ter admission to rehabcentre !a"ter control o" orthostatic

h'potension+ Paraplegics 5ith dela'ed admission

ma' come 5ith o5n chair

(c2uisition highl' dependent on donoraailabilit' !Aood "or the Poor+


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,ne h*ndred and !o*r - /atients 0ho had

been discharged !rom the ir 1ohn 2olding

ehabilitation -entre bet0een "#$# and the

!irst si months o! "#$" 0ere identi!ied.

-ontact 0as made 0ith these /ersons and an

intervie0 cond*cted by tele/hone.


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4F TAT6

7*mber alive8 9% n:99

7*mber deceased8 $5% n:$+

7*mber 0e lost contact 0ith8 $$% n:$$


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6nder "#8 $3% n:$3 "#;#8 5% n:9

$;+#8 3#% n:3$ ,ver +#8 $3% n:$3


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$H

:$H

#$H

8$H


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-aregiver8 5


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A7 A7 7-,M8 $#% n:

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Care of New Traumatic SCI Patients in Jamaica