Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

Can J Surg 2020;63(3):E315-E320 | PDF

Syed Uzair Ahmed, MD; Suzanne Humphreys, MSc; Carly Rivers, PhD; Melanie Jeffrey, PhD; Daryl R. Fourney, MD

Abstract

Background: People of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay.

Methods: This was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations.

Results: Of the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly.

Conclusion: This study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.

Résumé

Contexte : Au Canada, les personnes d’origine autochtone sont plus susceptibles que les autres de vivre un traumatisme médullaire. Malgré cela, il y a peu d’études sur les conséquences de cet événement. Notre étude visait à comparer les cas de traumatisme médullaire aigu dans les populations autochtones et non autochtones sur plusieurs plans : les caractéristiques initiales des patients, la gravité du traumatisme, la nature du traitement, les issues cliniques et la durée de séjour.

Méthodes : Nous avons fait une analyse rétrospective des dossiers de personnes ajoutées au Rick Hansen Spinal Cord Injury Registry (RHSCIR) [Registre des traumatismes médullaires Rick Hansen] entre le 13 février 2010 et le 17 décembre 2016 pour l’établissement de Saskatoon (l’Hôpital universitaire Royal). Nous avons comparé les renseignements de base des patients ainsi que les données sur le traumatisme et la prise en charge afin de cerner toute différence entre les populations.

Résultats : Sur les 159 traumatisés médullaires admis à l’Hôpital universitaire Royal pendant la période à l’étude, 62 ont consenti à l’utilisation de leurs données. Parmi eux, 21 s’étaient identifiés comme Autochtones (33,9 %) sur le formulaire d’hospitalisation, et 41 comme non-Autochtones (66,1 %). Par rapport aux non-Autochtones, les Autochtones étaient plus jeunes, avaient moins de comorbidités, présentaient une atteinte neurologique de gravité comparable et connaissaient à peu près le même tableau clinique. Toutefois, le délai avant leur retour en communauté était significativement plus long (médiane : 104,0 jours contre 34,0 jours; p = 0,016). Aucun participant autochtone n’a été renvoyé directement à la maison, alors que 35 % des participants non autochtones sont retournés chez eux en quittant les soins de première ligne.

Conclusion : Cette étude montre qu’il faut améliorer la répartition des ressources de retour dans la communauté pour les traumatisés médullaires autochtones de la Saskatchewan. Enfin, nous comptons examiner les répercussions cliniques du traumatisme médullaire chez les Autochtones de partout au Canada.


Accepted Oct. 24, 2019

Affiliations: From the Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Ahmed, Fourney); the Rick Hansen Institute, Vancouver, B.C. (Humphreys, Rivers); and the Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, Toronto, Ont. (Jeffrey).

Funding: At the time of writing, M. Jeffrey was a postdoctoral fellow funded by the Rick Hansen Institute. The Rick Hansen Spinal Cord Injury Registry is supported by funding from Health Canada, Western Economic Diversification Canada and the governments of Alberta, British Columbia, Manitoba and Ontario. The funding agencies had no role in the study or study reporting.

Competing interests: None declared.

Contributors: S. Ahmed and D. Fourney designed the study. S. Ahmed, S. Humphreys and D. Fourney acquired the data, which all authors analyzed. S. Ahmed and D. Fourney wrote the article, which all authors critically reviewed. All authors approved the final version to be published.

DOI: 10.1503/cjs.012819

Correspondence to: D.R. Fourney, Division of Neurosurgery, University of Saskatchewan, 103 Hospital Dr, Saskatoon SK S7H0K7, daryl.fourney@usask.ca