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Abstract

RÉSUMÉ
Introduction. Les traumatismes vertébro-médullaires (TVM) sont une cause majeure de handicap dans les pays à ressources limitées, où les cohortes ouest-africaines demeurent rares. L'objectif était d'identifier les facteurs associés à la mortalité hospitalière (critère principal) et à la récupération neurologique (secondaire). Matériels et méthodes. Cohorte monocentrique (phase rétrospective 2017-2021, phase prospective 2025-2026) de 366 patients porteurs d'un TVM confirmé, rapportée selon STROBE. La récupération était définie par un gain d'au moins un grade ASIA chez les survivants classés ASIA A-D à l'admission. Deux modèles de régression logistique multivariée ont été construits, avec évaluation de leur discrimination et de leur calibration. Résultats. L'âge médian était de 35 ans (80,9 % d'hommes) ; les accidents de la voie publique dominaient (62,6 %) et 71,9 % des patients étaient référés. Une lésion complète (ASIA A) concernait 40,2 % des patients, une atteinte cervicale 50,0 % ; 94,3 % ont été opérés. La mortalité hospitalière était de 17,5 % ; 120 des 262 survivants ASIA A-D (45,8 %) ont gagné au moins un grade. Le grade ASIA A était le seul facteur indépendant de mortalité (OR ajusté 10,7 ; IC 95 % 5,3-21,7 ; AUC 0,79), avec une mortalité de 35,4 % contre 5,5 %. Aucune covariable n'était associée à la récupération (AUC 0,60). Conclusion. La sévérité neurologique initiale prédit le décès hospitalier, mais non la récupération, qu'aucune variable d'admission ne prédit. Il déplace l'attention vers les leviers systémiques modifiables : orientation précoce, transport médicalisé, accès à l'imagerie, chirurgie spécialisée et rééducation effectivement dispensée.
ABSTRACT
Introduction. Traumatic spinal injuries (TSI) are a major cause of lasting disability in resource-limited settings, where French-speaking West African cohorts remain scarce. The aim was to identify factors associated with in-hospital mortality (primary outcome) and neurological recovery (secondary outcome). Materials and methods. Single-centre cohort (retrospective phase 2017-2021, prospective phase 2025-2026) of 366 patients with confirmed TSI, reported according to STROBE. Recovery was defined as a gain of at least one ASIA grade among survivors initially graded ASIA A-D. Two multivariable logistic regression models were built, with assessment of discrimination and calibration. Results. Median age was 35 years (80.9 % men); road traffic crashes predominated (62.6 %) and 71.9 % of patients were referred. A complete lesion (ASIA A) was present in 40.2 %, a cervical injury in 50.0 %, and 94.3 % underwent surgery. In-hospital mortality was 17.5 %; 120 of the 262 survivors graded ASIA A-D (45.8 %) gained at least one grade. ASIA A was the only factor independently associated with mortality (adjusted OR 10.7; 95 % CI 5.3-21.7; AUC 0.79), with mortality of 35.4 % versus 5.5 %. No covariate was associated with recovery (AUC 0.60). Conclusion. Initial neurological severity predicts in-hospital death but not recovery, which no clinical variable available on admission predicts. This shifts attention towards modifiable system-level levers: early referral, medicalised transport, access to imaging, specialised surgery and rehabilitation actually delivered.
ABRÉVIATIONS : ASIA, American Spinal Injury Association Impairment Scale ; AUC, aire sous la courbe ROC ; AVP, accident de la voie publique ; IC, intervalle de confiance ; IQR, intervalle interquartile ; IRM, imagerie par résonance magnétique ; ISNCSCI, International Standards for Neurological Classification of Spinal Cord Injury ; OR, odds ratio ; PRFI, pays à revenu faible ou intermédiaire ; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology ; TDM, tomodensitométrie ; TVM, traumatisme vertébro-médullaire

Keywords

spinal cord injuries; ASIA impairment scale; Côte d'Ivoire; hospital mortality; prognosis traumatisme vertébro-médullaire ; ASIA ; Côte d'Ivoire ; mortalité hospitalière ; pronostic

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How to Cite
Teti Faozo Stéphane Landry, Dongo Koffi Yves Soress, Fionko Yao Bernard, Yao Konan Serge, Keke Kouadio Jean-Baptiste, Kouassi Koffi Jean-Jacques, … Haidara Adérehime. (2026). Traumatic Spinal Injuries in Côte d’Ivoire: Factors Associated with In-Hospital Mortality and Neurological Recovery in a Cohort of 366 Patients: Traumatismes Vertébro-Médullaires en Côte d’Ivoire : Facteurs Associés à la Mortalité Hospitalière et à la Récupération Neurologique dans une Cohorte de 366 Patients. HEALTH SCIENCES AND DISEASE, 27(10), 154–162. https://doi.org/10.67260/hsd.v27i10.7924
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