Epidemiology of spinal cord injuries in the 2005 Pakistan earthquake
Farooq Azam Rathorea, Per Örtenwall Moheb A. Rashida, A W Butta, A A Malika, Zaheer Ahmed Gilla, Andrew J. Haigb c
- aSpinal Rehabilitation Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
- bDepartment of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, MI, USA
- cDepartment of Physical Medicine and Rehabilitation, The University of Michigan, Ann Arbor, USA
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Abstract
Study design: Prospective observational study. Objectives: To identify the epidemiological features specific to spinal injuries as a result of an earthquake. Settings: Rawalpindi, Pakistan in the months after the 8 October 2005 earthquake. Methods: In the month after the earthquake, the one established rehabilitation center was augmented with two makeshift spinal cord centers. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. Neurological status and functional outcome was determined after 10 weeks. Results: Of an estimated 650-750 spinal cord injuries, 187 were admitted to these centers, including 80 men and 107 women with a mean age of 28.3+/-12.4 years. Injuries occurred while standing in 57.8% of patients. Most (83.4%) who reached the spinal cord center were airlifted. A urinary catheter had been placed before admission in 91.5%. Most of the patients were paraplegic 89.3, with 50.8% incomplete injuries. Fracture or fracture dislocation was present in 70, and 75% underwent spinal fixation. Although pressure ulcers (28.9%) and urinary tract infections (39%) were common, deep venous thromboses (4.8%) and depression (5.8%) were seldom detected. At 10 weeks, 75% were continent or performing intermittent catheterization. There were no deaths and two births. Conclusion: After a disaster, evacuation of persons with a spinal cord injury to a specialized center results in low mortality. Response planning for disasters should include early aggressive medical rehabilitation.