Landry M1,2, Sultana M3, Shoyeb K4, Tupetz A2
1Duke University, Physical Therapy Division, Durham, United States, 2Duke Global Health Institute, Durham, United States, 3Centre for the Rehabilitation of the Paralysed (CRP), Savar, Bangladesh, 4International Committee of Red Cross (ICRC), Cox's Bazaar, Bangladesh
Background: Spinal Cord Injury (SCI) rates are increasing worldwide. Bangladesh is a low and middle-income country (LMICs) who have highlighted an increase in a specific type of SCI known as a Scarf Injury. The mechanism of injury for the Scarf Injury occurs when a traditional scarf worn by Bangladeshi women becomes entangled in the drive shaft of an autorickshaw taxi called the 'easy bike', generally resulting in deep anterior cervical lacerations and complete lesions of the spinal cord. The immediate survival rates at the site of injury, and the long-term survival rates are unknown.
Purpose: Patients presenting with a Scarf Injury are generally young females who present with a complete cervical SCI lesion. We sought to understand their 2-year survivorship among this patient population.
Methods: The Centre for the Rehabilitation of the Paralyzed (CRP) is the largest spinal cord rehabilitation facility in Bangladesh. CRP was able to provide high-level aggregated data on patients with Scarf Injuries who were admitted, and discharged, from CRP during the 5 year period between 2014 and 2018.
Results: Between 2014 and 2018, there were 40 patients with Scarf Injury who were admitted and then discharged to the community following a Scarf Injury. All patients were female, all had complete tetraplegia, 42.5% were below the age of 15 years, and 62.5% were students at the time injury. The 2-year survival rate of patients with Scarf Injury was 77.5% (22.50% mortality rate)
Conclusion(s): Previous research estimated the 2-year mortality of all SCI patients in the same rehabilitation center in Bangladesh to be 87.00%, and thus our findings demonstrate that a sub-group of patients with Scarf Injuries are much lower at 77.50%. Those who survive a Scarf Injury have complex medical, rehabilitative and social issues that are likely related to factors that are beyond the injury alone. Other research has demonstrated that many patients with Scarf Injury experience a greater degree of social isolation, stigma, and reduced access to follow up care. Given that patient with Scarf Injury are almost exclusively young females, there is thus an inculcation of gender issues that are pervasive across the world, but which are highlighted among people with disabilities.
Implications: Further qualitative and quantitative investigation is underway to understand the causes of death among both groups of patients with SCI. However given that we have found that patients with Scarf Injury have double the 2-year mortality rates, we can at minimum conclude that a more robust post discharge follow up care would likely undercover some of the reasons. Still, further, such follow up interventions, while resource intensive in a setting such as Bangladesh, might provide greater opportunity to intervene to bend the mortality curve among this particularly vulnerable population.
Keywords: mortality, disability, gender
Funding acknowledgements: No funding
Purpose: Patients presenting with a Scarf Injury are generally young females who present with a complete cervical SCI lesion. We sought to understand their 2-year survivorship among this patient population.
Methods: The Centre for the Rehabilitation of the Paralyzed (CRP) is the largest spinal cord rehabilitation facility in Bangladesh. CRP was able to provide high-level aggregated data on patients with Scarf Injuries who were admitted, and discharged, from CRP during the 5 year period between 2014 and 2018.
Results: Between 2014 and 2018, there were 40 patients with Scarf Injury who were admitted and then discharged to the community following a Scarf Injury. All patients were female, all had complete tetraplegia, 42.5% were below the age of 15 years, and 62.5% were students at the time injury. The 2-year survival rate of patients with Scarf Injury was 77.5% (22.50% mortality rate)
Conclusion(s): Previous research estimated the 2-year mortality of all SCI patients in the same rehabilitation center in Bangladesh to be 87.00%, and thus our findings demonstrate that a sub-group of patients with Scarf Injuries are much lower at 77.50%. Those who survive a Scarf Injury have complex medical, rehabilitative and social issues that are likely related to factors that are beyond the injury alone. Other research has demonstrated that many patients with Scarf Injury experience a greater degree of social isolation, stigma, and reduced access to follow up care. Given that patient with Scarf Injury are almost exclusively young females, there is thus an inculcation of gender issues that are pervasive across the world, but which are highlighted among people with disabilities.
Implications: Further qualitative and quantitative investigation is underway to understand the causes of death among both groups of patients with SCI. However given that we have found that patients with Scarf Injury have double the 2-year mortality rates, we can at minimum conclude that a more robust post discharge follow up care would likely undercover some of the reasons. Still, further, such follow up interventions, while resource intensive in a setting such as Bangladesh, might provide greater opportunity to intervene to bend the mortality curve among this particularly vulnerable population.
Keywords: mortality, disability, gender
Funding acknowledgements: No funding
Topic: Disability & rehabilitation; Globalisation: health systems, policies & strategies; Neurology: spinal cord injury
Ethics approval required: Yes
Institution: Duke University
Ethics committee: Institutional Review Board (IRB)
Ethics number: Pro00092024
All authors, affiliations and abstracts have been published as submitted.
