Pakistan 2005 post-earthquake disability relief project

About 750 people were identified with sustained spinal cord injuries (SCI) in the October 05 earthquake. Their management was complicated by the inadequate rehabilitation services. Those returning homes did not have access to proper follow-up services. Objectives To perform a follow up of earthquake 2005 paraplegics and assess their rehabilitation needs at the community level. Materials and methods Cross-sectional study in Muzaffarabad district. Patients initially registered voluntarily on telephone and later in the field. Sixty-seven spinal cord injury patients were enrolled. A five-member team was formed that collected data in Feb. 2007. Interviews were conducted and examinations carried out. Data was entered on semi-structured proformas and analyzed using SPSS. Results Of the 67 patients enrolled, 42 patients had suffered an SCI (24 male; 18 female). Thirty were earthquake affectees, while 12 sustained injury due to falls or road traffic accident. Predominantly patients (69%) were in their second and third decades, and had complete injuryASIA A (50 %). All were paraplegics with thoraco-lumbar injury. Pressure ulcers were present or had developed in eight, most with grade 2–3 ulcers. Co-morbid conditions were identified in 7%, while 33% had at least one complication. Recommendations/conclusions Early and adequate SCI rehabilitation leads to better outcomes, reduced complications. There is a need to improve community-based rehabilitation for the earthquake 2005 paraplegics to ensure their transition into mainstream society.

Prospective observational study. To assess the prevalence of symptomatic deep vein thrombosis (DVT) in earthquake survivors with spinal cord injury (SCI). Rawalpindi, Pakistan, in the months after the October 2005 earthquake. Earthquake survivors (n=187) with acute SCI were enrolled after verbal informed consent. Information on mechanism of injury, mode of evacuation, associated injuries was gathered, and a detailed clinical and radiological assessment was performed. They were followed for 10 weeks for clinical signs and symptoms suggestive of DVT. Case with clinical suspicion of a DVT underwent a duplex scan of both legs to confirm the diagnosis. The influence of age, gender, American Spinal Injury Association (ASIA) grade and lower limb fractures on occurrence of DVT was determined. There were 80 men and 107 women with a mean age of 28.3+/-12.4 years. Seventeen patients were clinically suspected to have a DVT and ultrasound was positive in nine (4.8%). There was no influence of age (P=0.4), gender (P=0.4), ASIA grade (P=0.1) or presence of a lower limb fracture (P=0.6) on the occurrence of a DVT. This study adds further evidence to support the belief that the incidence of DVT in Southeast Asian patients with an SCI is lower than the reported incidence in the West. It may not be necessary to apply the recommendations for DVT prophylaxis in Caucasians with SCI to other groups, including Southeast Asians.