title: Complications in patients with spinal cord injuries sustained in an earthquake in Northern Pakistan.
abstract: BACKGROUND
  Spinal cord injury (SCI) is a devastating trauma suffered by many of the victims of an earthquake that struck Northern Pakistan on October 8, 2005. It rendered approximately 600 patients paraplegic, which is the highest number ever reported in any disaster. This study was conducted to evaluate the risk of complications.
  
  
  METHODS
  The cross-sectional retrospective study covering a 2-month period was conducted on 194 patients admitted to the surgical/neurosurgical wards of Rawalpindi Medical College and allied hospitals (Holy Family Hospital, Rawalpindi General Hospital, and District Headquarter Hospital) and Melody Relief and Rehabilitation Center, Islamabad.
  
  
  RESULTS
  The male-to-female ratio was approximately 1:3 (n = 50 [26%] and n = 144 [74%], respectively). The majority (78% [n = 151]) were 16 to 39 years of age; 62% (n = 120) had lumbar-level injuries, 25% (n = 48) had thoracic-level injuries, 9% (n = 18) had thoracolumbar-level injuries, and a few had cervical- or sacral-level injuries. Forty-six percent (n = 90) had American Spinal Injury Association type A injuries; 4% (n = 8) were graded B, 11% (n = 21) were graded C, 9% (n = 18) were graded D, and 14% (n = 27) were graded E. Twenty percent (n = 39) developed pressure ulcers, of which 38% (n = 15) had grade 1, 36% (n = 14) had grade 2, 23% (n = 9) had grade 3, and 3% (n = 1) had grade 4. All patients developed urinary tract infections; 15% (n = 30) had bowel complaints; 2% (n = 3) developed deep-vein thrombosis (1 died of pulmonary embolism); and 0.05% (n = 1) developed wound infection.
  
  
  CONCLUSIONS
  Awareness of potential complications in patients with paraplegia is essential to care planning in the disaster setting. The priorities include skin, bowel, and bladder care and provision of prophylactic heparin. SCI post-disaster care requires comprehensive long-term planning.
authors.affiliation: Holy Family Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan. fizza.tauqir@gmail.com
authors.forename: Syeda Fizza
authors.initials: SF
authors.lastname: Tauqir
authors.forename: Shirin
authors.initials: S
authors.lastname: Mirza
authors.forename: Shahzad
authors.initials: S
authors.lastname: Gul
authors.forename: Hirra
authors.initials: H
authors.lastname: Ghaffar
authors.forename: Asif
authors.initials: A
authors.lastname: Zafar
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D015599:Trauma Severity Indices