Spinal Injuries at the University Hospital of the West Indies

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85 percent of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernisation of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilisation and transport, prompt resuscitation, the standardisation of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalisation of a well-coordinated and rehearsed Spine team.(Au)

Spinal Injuries at the University Hospital of the West Indies

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85 percent of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernisation of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilisation and transport, prompt resuscitation, the standardisation of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalisation of a well-coordinated and rehearsed Spine team.

Predictions and outcome of patients with skull fractures - Poster abstract

OBJECTIVE: To determine the clinical outcome of patients presenting to the University Hospital of the West Indies with head injuries including skull fractures. DESIGN AND METHODS: Data was retrieved from the Hospital trauma database for the period January 15, 1998 to October 9, 1999. RESULTS: Of 2126 injured patients admitted to the University Hospital of the West Indies over a 21 month period, 706 patients (32.2 percent) had head injuries, of whom 141 had skull fractures. The predominantly male group had an average age of 30 years. Overall, road traffic accidents were responsible for the majority of injuries, but intentional injuries were most common (48.2 percent) in those with skull fractures. A skull fracture was associated with a longer period of unconsciousness, a lower Glasgow coma scale, a higher injury severity score, longer hospital stay, higher probability of intracranial complications, a five times more frequent rate of operative intervention, and a worse outcome. Skull X-rays are readily available in most hospitals in the Caribbean compared to CT scanning for which access is often restricted due to cost and distance. CONCLUSIONS: The early identification of a skull fractue can identify patients at high risk for the development of intracanial complications after a head injury. These patients need urgent neurosurgical and neuroradiological assessment so that appropriate, prompt intervention can take place. Prevention of injury and early, effective assessment and treatment are the only ways in which this common problem can be mimimized.(AU)

The distribution of intracranial aneurysms at the University Hospital of the West Indies

Aneurysms of the brain were probably first recognized at necropsy by Morgagni in the 18th century. Autopsy data are at variance with the incidental findings in infancy and later life. Factors such as growth of aneurysm, size at equilibrium, clinical profile and radiological methods of detection play a role in determining the probability of an aneurysm being present and detectable in an individual at a given time. Most aneurysms do not rupture. Most intracranial aneurysms are found on the Circle of Willis (90 percent), the anterior communicating artery being most often quoted as the predominant site (30 to 35 percent). We have reviewed the cases presenting to the University Hospital of the West Indies between 1954 and 1997 in order to determine the distribution of intracranial aneurysms at that institution and potential management implications.(AU)

Exotic injuries of the central nervous system

Head injuries are the most common reason for admission among the injured at the University Hospital of the West Indies. Intentional injuries account for 52 percent of all trauma admissions. We report a unique group of 6 patients with central nervous system injuries, all intentional with the offending weapon in situ on arrival at hospital. 4 patients had weapons embedded in the head: two were knives, and one each was an ice-pick and a harpoon from a fishing device. The two other patients sustained spinal, cord injuries from ice-pick wounds. Principles of management involved radiological assessment of the injury to elucidate the position of the weapon, removal of the weapon under controlled circumstances in the operating theatre suite, prevention of infection and seizure prophylaxis. Operations performed were craniotomy, craniectomy and exploration of the spinal injuries. Two deaths occurred. In one, a spinal abscess developed six months after injury with the patient succumbing to sepsis. The other was an unexplained death following craniotomy and removal of a knive which severed the internal carotid artery. The cost of managing these intentional injuries was far greater than for the average patient and significantly demonstrates the burden on the taxpayer to treat these injuries(AU)

Head cutting

The machete is a farming tool widely used in the tropics, Asia and the atolls of the Pacific. Despite the emergence of sophisticated and efficient means of producing head wounds, the edged weapon is widely used in Jamaica to inflict injuries. Only three cases have been reported in the medical literature. We report 21 cases and suggest a protocol for the treatment of this modality of intentional injury. Over a seven year period, 21 patients with machete wounds to the head were admitted. 17 (80 percent) were male and 70 percent had injuries of the left side of the head. The Glasgow coma score (GCS) was normal in 15 and only three patients had a CSF leak of protruding brain matter. All patients received tetanus toxoid and intravenous antibiotics, most commonly cloxacillin (70 percent) and chloramphenicol (65 percent). Phenytoin was given in 55 percent of the total group and to all patients with seizures.(AU)

Rectal suction biopsy in the diagnosis of Hirschsprung's disease: a preliminary report - abstract

The Caribbean experience with the suction biopsy device in the diagnosis of Hirschsprung's disease has not been reported. This apparatus is widely used in Europe and North America. The preliminary experience at the University Hospital of the West Indies, Jamaica gained over 2 1/2 years indicates biopsies performed in 31 patients, 27 for chronic constipation with a possible diagnosis of Hirschsprung's Disease and 4 for rectal bleeding. Hirschsprung's disease was diagnosed in 4 cases and ulcerative colitis in 1 case, respectively. Operative bowel resection specimens confirmed rectal suction biopsy in all 4 cases of Hirschsprung's disease. Repeat suction biopsy was performed in 3 patients after preliminary specimens were inadequate for diagnosis. There were no complications resulting from biopsy. Rectal suction biopsy is a safe and reliable technique of obtaining specimens in the diagnosis of Hirschsprungs disease and its use is recommended for the Caribbean. (AU)

Childhood injuries in Jamaica - abstract

Childhood (age < 10 years) injuries were the reason for 225 emergency admissions to the Bustamante Hospital for Children and the University Hospital of the West Indies over a six week period ending June 30, 1996. Intentional injuries numbered 21 (9.3 percent) and unintentional injuries 204 (90.7 percent). Male/Female distribution was 143 (63.5 percent) and 82 (36.5percent). The average age of patients was 4.9 years. Falls, burns and motor vehicle accidents were the common causes of injuries resulting in 125 (55.5 percent), 19 (8.4 percent) and 17 (7.5 percent) admissions respectively. Bony, head and soft tissue injuries numbered 79 (35 percent), 63 (28 percent) and 35 ( 15.5 percent) respectively. Injury severity was graded according to the Tepas trauma score with severe injuries receiving grade 8 and lower. These totalled 22 affecting head (9), bone (8), and multiple sites (5). There were two deaths: a severe head injury (Tepas score 5) and a case of 35 percent flame burns. (AU)