Article
Pain management and patient satisfaction after traumatic spinal injury in sub-Saharan Africa – international collaborative study using a prospective spine trauma registry
Schmerztherapie und Patientenzufriedenheit nach einer Wirbelsäulenverletzung in Subsahara-Afrika – Internationale kooperative Studie basierend auf einem prospektiven Wirbelsäulentrauma-Register
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Authors
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Raphael Greving
- Neurochirurgische Klinik, Universitätsklinikum Gießen, Gießen, Deutschland
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Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurosurgery, New York, United States
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Hamisi Shabani
- Muhimbili Orthopedic and Neurosurgical Institute, Department of Neurosurgery, Dar-es-Salaam, United Republic of Tanzania
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Nicephorus Rutabasibwa
- Muhimbili Orthopedic and Neurosurgical Institute, Department of Neurosurgery, Dar-es-Salaam, United Republic of Tanzania
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Albert Lazaro
- Muhimbili Orthopedic and Neurosurgical Institute, Department of Neurosurgery, Dar-es-Salaam, United Republic of Tanzania
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Salim Msuya
- Muhimbili Orthopedic and Neurosurgical Institute, Department of Neurosurgery, Dar-es-Salaam, United Republic of Tanzania
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Andreas Leidinger
- Weill Cornell Brain and Spine Center, Department of Neurosurgery, New York, United States
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Eliana Kim
- Weill Cornell Brain and Spine Center, Department of Neurosurgery, New York, United States
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Karsten Schöller
- Neurochirurgische Klinik, Universitätsklinikum Gießen, Gießen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Traumatic spine injuries (TSI) have an extraordinary relevance for the burden of disease in sub-Saharan Africa (SSA). However, data on epidemiology and management of TSI in this region is almost nonexistent. In Dar-es-Salaam, Tanzania, a local prospective TSI registry was implemented in an international collaborative effort to obtain systematic data in SSA. Our study aims to gain insight into the current state of pain management in TSI patients, and to get an impression on patient satisfaction.
Methods: All patients with TSI that were admitted to the collaborating neurosurgical institution in Tanzania between 12/2017 and 10/2018 were included in this prospective registry study. Baseline data included demographic as well as clinical parameters, e.g. American Spinal Injury Association (ASIA) grade. Average pain levels (Numeric-Rating-Scale) and pain medication (WHO steps) were assessed on admission, postoperatively, and at discharge. Patient satisfaction was documented using an 8-item-score (max. points/item: 10).
Results: We included n=70 patients with a median age of 34 years in our study; the median follow-up was 29 days. 41.2% of the patients (pts.) sustained a thoracic trauma, while 29.4% of the injuries were localized in the cervical spine, 17.6% in the lumbar region, and 11.8% in the transitional zones. Complete spinal cord injury (ASIA-A) occurred in 52.9% of the pts., while an ASIA B-D injury occurred in 27.1% ; 20.0% of the pts. had no neurological deficit. Average pain level on admission was 3.4±2, which significantly (p<0.001) decreased until discharge (Ø 0.8±0.8). Pts. who underwent surgery (44.2%) had a temporary postoperative increase of pain (Ø 4.7±1.9). Pain on admission was mainly (92.6%) managed with WHO step 1 medication, while postoperative pain was primarily (96.8%) managed with WHO step 2 analgesics. At discharge an overall reduced level of medication was noted (WHO Step 1: 59.7%; no medication: 37.1%). Pain management was rated as the most satisfying item by the pts. (Ø 7.9±1.8), physiotherapy (Ø 6.8±1.8) and the length of stay (LOS; Ø 6.6±2.1) as least satisfying.
Conclusion: This is the first study on pain, pain management and patient satisfaction in TSI patients in SSA. Pain management seems to be overall sufficient, but can clearly be optimized in the early postoperative phase. Physiotherapy and LOS as sources of patient dissatisfaction need to be addressed in more detail to better implement future improvements.
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