Incidence Of Traumatic Spinal Cord Injury Research Articles

Clinical Characteristics and Outcomes of Patients with Traumatic Spinal Cord Injury at a Tertiary Care Center in the Philippines

Traumatic Spinal Cord Injury (TSCI) is a devastating condition which may result to lifelong complications that impact patient outcome and quality of life. Due to the increasing incidence of TSCI, it is important to comprehend the extent of this condition in terms of demographics, mechanism, and degree of disability to raise awareness and develop strategies in approaching care for these patients. There is lack of information regarding data on TSCI in Southeast Asia, especially in the Philippines. This study aims to describe the clinical characteristics and outcomes of patients with TSCI in a tertiary care hospital in the Philippines. This is a retrospective descriptive cohort study in individuals aged 18 years and above, who were admitted for TSCI in a Philippine tertiary care hospital between 2022 and 2023. Of 118 admitted patients, 100 patients were included in the study. The data were obtained from the review of patients' medical records. Demographics of TSCI, mechanism, presenting clinical characteristics, American Spinal Injury Association Impairment Scale (AIS) grade, radiographic findings, outcomes, and complications were analyzed. A total of 100 patients with TSCI were included in the study. The mean age of the patients is 43.4 ± 15.8 in years with males being predominant, 92%. The most common mechanism of injury was motor vehicular crash (MVC), 68%. followed by fall, 22%. Majority of patients were graded AIS C, 38% on admission. The most common level of injury is cervical, 70%. The usual complications recorded were sacral ulcer 28%, and Hospital Acquired Pneumonia (HAP), 20%. TSCI is common in young adult males with MVC as mechanism of injury. Majority of patients in the study had incomplete spinal cord injury (AIS C), with the cervical region as the most common level. The recorded mean length of hospital stay was 1-2 weeks. The most common co-occurring extra spinal injury was TBI. Upon discharge, majority developed sacral ulcer and HAP, with stable neurologic status. A multi-center prospective data collection with a larger population and inclusion of more variables are necessary to formulate a regression model and establish the factors that improve the outcomes of TSCI.

Traumatic spinal cord injury in South Korea for 13 years (2008–2020)

Traumatic spinal cord injury (TSCI) has significant physical, psychological, and socioeconomic impacts. However, the epidemiological characteristics and treatment patterns of TSCI in South Korea remain unclear. This study aimed to investigate TSCI incidence and treatment behaviors in South Korea from 2008 to 2020. We included data from 30,979 newly diagnosed TSCI patients obtained from the Health Insurance Review and Assessment Service (HIRA). Treatment trends, location of surgery, surgical method, comorbidities, factors affecting hospital stay, and risk factors affecting readmission were analyzed. Patients were divided into the surgery group [n = 7719; (25%)] and the non-surgery group [n = 23,260; (75%)]. Surgical cases involved cervical (64%), thoracic (17%), and lumbar/sacral (19%) lesions. Anterior fusion (38%), posterior fusion (54%), and corpectomy (8%) were the surgical methods. Surgical treatments increased annually. Factors influencing hospital stay included male sex, older age, and higher Charlson comorbidity index (CCI). Female sex and higher CCI scores were associated with readmission. In conclusion, a quarter of all TSCI patients underwent surgery, with an upward trend. Risk factors for longer hospital stays were thoracic spine injury, older age, higher CCI, and male sex. Risk factors for readmission included age range of 40–59 years, lumbar/sacral spine injuries, CCI score of 2, and female sex.

Traumatic spinal cord injury: A four-year study in Puerto Rico

Objective Assess the occurrence of traumatic spinal cord injury (TSCI) in Puerto Rico, a geographically delimited territory. Design Retrospective review of data from all encounters with ICD-10-CM codes S12-14, S22-24, S32-34, G82.2 and G82.5 for years 2019-2022. Setting Puerto Rico Trauma Hospital. Outcome measures Patient (sex, age) and injury characteristics (neurological level, mechanism of injury, severity score, length of stay, mortality, and disposition). Results Annual incidence rates did not change over time with an increasing trend among older adults (P = 0.08). Median age was 44 yrs and 85% were men. The most frequent neurological level was thoracic (P = 0.03). Falls were the most common mechanism and was associated with age (P < 0.0001). In-hospital mortality was 24.8%, higher (P = 0.05) in 2020-2021. Median length of stay was 26 days, higher (P = 0.014) in 2020-2021. An increase (P < 0.001) over time in discharges to inpatient rehabilitation was observed. The SARS-CoV-2 lockdown resulted in fewer and older patients; more cervical injuries and falls; longer length of stay, and higher in-hospital mortality. Conclusion The risk of TSCI in Puerto Rico was 74% lower than in the United States. The incidence of TSCI in older adults in Puerto Rico appears to be on the rise due to falls. Preventive strategies should include fall prevention education and social interventions to decrease motor vehicle accidents and firearm violence. Disasters such as the COVID-19 pandemic, can change demographic trends in TSCI. Trauma centers should consider implementing a physiatry consult service to improve patient disposition.

Epidemiology of spinal cord injury and spinal cord injury–induced urinary tract stones in Taiwan: A 2005–2015 population-based cohort study

Context Patients with spinal cord injury (SCI) can develop urinary tract stones (UTSs) up to years after the injury, which is especially common in the first few months. However, relevant epidemiological studies and up-to-date epidemiological data for SCI in Taiwan are lacking. Purpose To estimate SCI and SCI-induced UTS incidence and trauma severity, neurological deficits, and injury site in patients with SCI-induced UTSs in Taiwan. Design Retrospective cohort study. Patient sample: Taiwan National Health Insurance Research Database (NHIRD) data and death data from the Department of Health and Welfare Data Science Center (HWDC) collected over 2005–2015 from 13,977 patients with SCI aged >18 years. Outcome measures Cumulative incidence (CI), incidence density (ID), relative ratios (RRs), odds ratios (ORs), and hazard ratios (HRs) were measured. Methods By using Cox regression, we assessed UTS risk in patients with SCI. Results Although standardized SCI incidence demonstrated a decreasing trend annually, the average annual incidence remained at 60.4 per million. Most (65.7%) of the included patients were men. SCI incidence was 1.98 times higher in men than in women. The most common injury site was the cervical spine (63.8%); the incidence at this site was 2.83 times higher in men than in women. Most (76.1%) of the patients had traumatic SCI (TSCI), and the standardized incidence of TSCI and non-TSCI was 45.9 and 14.4 per million, respectively. 46.1% of the patients had severe SCI (RISS ≥ 16). Over the 11-year follow-up period, UTSs occurred in 10.4% of the patients, with a standardized incidence of 2.39 per 100 person-years, and UTS risk was 1.56 times higher in men than in women. Age of 45–65 years, SCIs at multiple sites, and neurological deficits (e.g. paraplegia) were noted to be UTS risk factors. Finally, UTS onset mainly occurred in the first year after SCI. Conclusion The risk of UTS among patients with SCI is influenced by age, sex, injury site, and paraplegia but not by paralysis resulting from other neurological deficits. Even though SCI incidence is declining annually, severe SCI remains a significant issue. Therefore, continuing to reduce SCI incidence and strengthening urinary tract management in patients with SCI are essential for reducing UTS occurrence and their impact on health.

The impact of COVID-19 and associated lockdowns on traumatic spinal cord injury incidence: a population based study

Study designNatural experimentObjectivesTo determine whether COVID-19 restrictions were associated with changes in the incidence of traumatic spinal cord injury (TSCI) in Scotland.SettingThe Queen Elizabeth National Spinal Injuries Unit (QENSIU), the sole provider of treatment for TSCI in Scotland.MethodsTime series analysis of all admissions for TSCI between 1st January 2015 and 31st August 2022.ResultsOver the 8-year study period, 745 patients were admitted to the QENSIU with a TSCI. Interrupted time series analysis showed that level 3 and 4 COVID-19 lockdown restrictions (the most severe levels) were associated with lower incidence of TSCI (RR 0.63, CI% CI 0.47, 0.82, p < 0.001). The associations were stronger in people aged over 45 (additive interaction p = 0.001), males (additive interaction p = 0.01) and non-tetraplegia (additive interaction p = 0.002). The incidence of TSCI due to deliberate self-harm was higher (0.41 versus 0.23 per month) during restrictions.ConclusionsOverall, TSCI incidence reduced in Scotland when lockdowns were implemented, presumably due to lower engagement in risky activities. The increase in TSCI due to deliberate self-harm may reflect increased mental health problems and social isolation and should be anticipated and targeted in future pandemics. The change in incidence during the COVID-19 pandemic may have an economic impact and see a temporary reduction in the burden on health and social care. The results of this study will be useful for resource planning in future pandemics.

Management gaps of traumatic spinal cord injuries in war-torn low and middle-income nations: why has this massive problem garnered little attention? Editorial.

Management gaps of traumatic spinal cord injuries in war-torn low and middle-income nations: why has this massive problem garnered little attention? Editorial.

Spinal Cord Injury Fact Sheet in Korea.

Spinal cord injury (SCI) has been recognized as a medically complex and life-disrupting condition. As the aging of the population accelerates, the trend of SCI has changed. This review aimed to provide comprehensive statistics and recent epidemiological changes in SCI and rehabilitation in Korea. All three insurance databases (National Health Insurance Service [NHIS], automobile insurance [AUI], and industrial accident compensation insurance [IACI]) were considered. These nationwide databases provide data on the current trends in term of incidence, etiology, and rehabilitation of SCI. Traumatic spinal cord injury (TSCI) was more frequent among the elderly in the NHIS compared to working age individuals in the AUI and IACI. In all three trauma-related insurance databases, male with TSCI outnumbered female. TSCI incidence per year was approximately 17 times higher among males than females, on average, in IACI. In all three insurances, the cervical level of TSCI was the most frequent. Although the ratio of SCI patients receiving rehabilitation treatment at primary and secondary hospitals increased for nine years, the increase in training on activities of daily living (ADL training) was found to be relatively small. This review provides a broader and comprehensive understanding of the incidence, etiology, and rehabilitation treatment of SCI in Korea.

Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea.

To examine the incidence of traumatic spinal cord injury (TSCI) from all etiologies, we measured and compared the incidence of TSCI from three national or quasi-national databases in South Korea, namely, the National Health Insurance Service (NHIS), automobile insurance (AUI), and Industrial Accident Compensation Insurance (IACI). We reviewed patients with TSCI reported in the NHIS database between 2009 and 2018, and in the AUI and IACI databases between 2014 and 2018. TSCI patients were defined as those first admitted to the hospital with a diagnosis of TSCI according to the International Classification of Diseases (10th revision) criteria. Age-adjusted incidence was calculated using direct standardization using the 2005 South Korean population or the 2000 US population as the standard population. The annual percentage changes (APC) of TSCI incidence were calculated. The Cochrane-Armitage trend test was performed according to the injured body region. In the NHIS database, age-adjusted TSCI incidence using the Korean standard population increased significantly from 2009 to 2018 (from 33.73 per million in 2009 to 38.14 per million in 2018, APC = 1.2%, P = 0.014). Contrarily, age-adjusted incidence in the AUI database significantly decreased from 13.88 per million in 2014 to 11.57 per million in 2018 (APC = - 5.1%, P = 0.009). In the IACI database, the age-adjusted incidence showed no significant difference, while crude incidence showed a significant increase (from 22.02 per million in 2014 to 28.92 per million in 2018, APC = 6.1%, P = 0.038). According to the age group, all the three databases showed high incidences of TSCI in those in their 60s and 70s or older. Among those in their 70s or older, the incidence of TSCI increased dramatically in the NHIS and IACI databases, while no significant trend was found in AUI database. In 2018, the number of TSCI patients was the highest among those over 70 years of age in the NHIS, whereas among those in their 50s were the highest in both AUI and IACI. The proportion of patients with cervical spinal cord injury was the most common in all these databases. The differences in trends in the incidence of TSCI may be due to the different etiologies and different characteristics of subjects depending on insurance type. These results imply the need for tailored medical strategies for the different injury mechanisms represented by three national insurance services in South Korea.

Burden of traumatic spinal cord injury in Africa: a scoping review protocol

AbstractTrauma accounts for about 90% of spinal cord injuries worldwide. Traumatic spinal cord injury (TSCI) is recognized as a neurotrauma of global health priority due to the preventability of the injuries and the specialized and expensive medical and surgical care they necessitate. This study protocol guides the comprehensive and exhaustive review of the literature concerning the epidemiology, management and outcomes of TSCIs in Africa. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The search strategy was performed primarily on PubMed and OVID Embase. A secondary literature search was carried out on African Journal Online and Google Scholar. All observational studies on the prevalence/incidence, presentation, management and outcomes of TSCIs in African countries were included. The following study types were excluded: literature reviews, meta-analyses, case reports, abstract-only articles, conference proceedings, randomized control trials and letters to the editor. Our outcomes include incidence of TSCIs in Africa, mechanisms of injury, different imaging and treatment modalities offered (e.g. conservative vs. operative intervention), clinical outcomes following TSCIs in Africa and challenges regarding the management of TSCIs in African surgical centres. This study aims to provide region-specific data that will guide and inform local practices regarding TSCIs. It will also map out areas that need more research and areas amenable to intervention by global health stakeholders.

Characteristics of Pediatric Spinal Cord Injury in South Korea: A Single-Centered Study.

To determine the characteristics of pediatric spinal cord injury (SCI) in South Korea from 1990 to 2019. This single-centered retrospective study included pediatric SCIs. Individuals were divided into the following five groups according to onset age: ≤5, 6-12, 13-14, 15-17, and 18-19 years. The severity of complete injury was graded according to the American Spinal Injury Association impairment scale A (AIS A). Incomplete injury was graded according to AIS B, C, and D. Pearson chi-square test was used for statistical analysis. Of the 267 individuals included, 216 (80.9%) had traumatic SCIs (male-to-female ratio of 3.2:1), and 51 (19.1%) had non-traumatic SCIs (male-to-female ratio of 0.7:1). In the traumatic SCI group, 192 (88.9%) individuals were ≥15 years at the time of injury (males, 78.6%). The most common etiologies of traumatic SCIs, ranging from most to least common, were accidents related to motorcycles, falls, cars, and diving. In the non-traumatic SCI group, inflammatory (33.3%) and neoplastic (25.5%) etiologies were found to be the most common ones. We found that traumatic SCIs incidence in the pediatric population was high, particularly in male individuals aged 15-19 years. The non-traumatic SCIs mostly cause paraplegia and incomplete injury. Therefore, it can be used as a basic data for the evaluation, treatment and prevention strategy of pediatric patients with SCI.

Epidemiology of traumatic spinal cord injury: a large population-based study.

Study designA retrospective population-based study.ObjectivesDescribe the incidence of traumatic spinal cord injury (TSCI) and mortality risks, based on the characteristics of the patient, anatomical level of the lesion, setting/cause of the injury, and type of healthcare support received within the regional trauma network (highly specialized trauma center or spoke hospital).SettingBetween 2011 and 2020, 1303 patients with incident TSCI were identified in a population of 4.9 million inhabitants.MethodsHospital discharge records and mortality records were used to identify patients and outcomes. Cox regression models were fitted to estimate mortality risks across several subgroups.ResultsOver the past decade, age-sex-standardized TSCI incidence rates remained stable with 26.5 cases (95% CI, 25.0–27.9) per 1,000,000 inhabitants (mean age 59.2 years) and most cases were males (68.3%). Incidence was directly associated with age while the male to female ratio was inversely related. Most TSCIs were cervical lesions (52.1%), and the most common cause of injury were traffic crashes (29.9%) followed by occupational accidents (29.8%). Sex, cause of the trauma, or inpatient hospital management were not associated with an increased risk of death. Mortality rates were greater for cervical lesions, and increased with age, remaining stably high among older individuals even 12 months after the accident. One-month mortality risk was significantly higher at ≥75 years compared to <55 years (adjusted HR 9.14 (95% CI, 4.17–20.03)).ConclusionPublic health policies should aim at reducing preventable TSCIs, and special attention should be drawn to long-term management of elderly patients in the attempt to decrease mortality rates.

Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries - a systematic review with meta-analysis.

Systematic review with meta-analysis. To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001-2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15-29 age-group decreases from 50% (1961-1980) to 20% (2001-2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961-1980) to 27% (2001-2020). Conversely, fall-related injuries increase from 32% (1961-1980) to 46% (2001-2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961-1980) to 43% (2001-2020), while complete paraplegia decreases from 25% to 16%. The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.

Pattern Of Traumatic And Non-Traumatic Spinal Cord Injuries - A Hospital Based Study In Haryana

The demographic characteristics and rehabilitation outcomes of patients with traumatic spinal cord injury (T-SCI) have been extensively studied across the globe, whereas there has been limited research done on patients with non- traumatic spinal cord injury (NT-SCI). Studies observing the patterns and statistics of both T-SCI and NT-SCI are insufficient in developing countries, especially in India. Thereby, a retrospective cross-sectional study was conducted to evaluate the factors involved to improve the management of SCI. The aim of this study was to analyze the demographic profile and injury pattern of persons admitted with T-SCI and NT-SCI in a paraplegic rehabilitation center from August, 2015 to May, 2019. The injury pattern of 663 patients was observed in the present study, with ratio of T-SCI: NT-SCI of 4.30:1. Highest incidence of T-SCI and NT-SCI was found in the rural male population in the age group of 20-29 years and 30-39 years. Fracture and Pott’s spine disease with an incidence of 72.1% and 17.49% of SCI were primary etiologies for T-SCI and NT-SCI respectively, with maximum occurrence in the thoracolumbar region. On comparing T-SCI with NT-SCI based on the level of spinal injury, the ratio of TSCI: NT-SCI in cervical spine was 58.33:1; 1.89:1 in thoracic spine and 8.6:1 in lumbar spine. Lower percentage of cervical injuries and prevalence of thoracolumbar injuries in T-SCI category and prevalence of Pott’s disease in NT-SCI category, predict that demographic profile of both T-SCI as well as NT-SCI in India is different from developed countries. There is a need for upgradation of the first-aid services and rural health care facilities for effective management of injuries of cervical spine. Eradication of tuberculosis through definitive measures is the need of hour for prevention and effective management of NT-SCI.

Prevalence, Incidence, and External Causes of Traumatic Spinal Cord Injury in China: A Nationally Representative Cross-Sectional Survey.

Background and PurposeThe epidemiological characteristics of traumatic spinal cord injury (TSCI) in China are unclear. Thus, we aimed to study prevalence, incidence, and external causes of TSCI in China nationwide.MethodsIn 2013, we conducted a nationally representative, door-to-door epidemiological survey on TSCI in China using a complex, multistage, probability sampling design.ResultsIn China, the point prevalence of TSCI standardized to the China census population 2010 was 569.7 (95% CI: 514.2–630.4) per 1,000,000 in the population, 753.6 (95% CI: 663.3–854.3) per 1,000,000 among men, and 387.7 (95% CI: 324.8–461.1) per 1,000,000 among women. The incidence of TSCI standardized to the China census population 2010 was 49.8 (95% CI: 34.4–70.7) per 1,000,000 per year in the population, 63.2 (95% CI: 38.9–98.5) per 1,000,000 among men, and 36.9 (95% CI: 19.5–65.9) per 1,000,000 among women. Among the 415 TSCI events in 394 prevalent cases, the top three injury causes were falls (55.2%), motor vehicle collisions (MVCs) (26.5%), and strike injuries (10.1%), while other injury causes including gunshot and explosion accounted for 8.2%. Among the 394 prevalent cases, the mean age of patients at the time of injury was 43.7 ± 17.1 years; the male-to-female ratio was 1.86:1.ConclusionIt is estimated that there are 759,302 prevalent patients with TSCI in total and 66,374 new TSCI cases annually in China. Falls and MVCs are still 2 major external causes for TSCI in China.

Epidemiology of Traumatic Spinal Cord Injuries in Iran; a Systematic Review and Meta-Analysis.

Understanding the epidemiology of traumatic spinal cord injuries (TSCIs) can be helpful for policymakers and planners to consider appropriate strategies to control and prevent these injuries. This study aimed to determine the epidemiological characteristics of TSCI in Iran in order to increase knowledge and awareness of these injuries. A systematic literature search was conducted up to January 2022 in the electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, SID, Iranmedex, and Magiran. The quality of included studies was evaluated using the STORBE checklist. Comprehensive meta-analysis was used to analyze the data. Nineteen studies involving 9416 cases were included in the study. Participants' pooled mean age was 35.80 ± 1.07 years (95% CI: 33.69 to 37.91), of whom 69% (95% CI: 68% to 70%; P<0.05) were male. The most frequent TSCI occurred in the age group of less than 30 years. Motor vehicle collisions (MVCs) was the most common cause of TSCI (57%; 95% CI: 25% to 63%), followed by falls (32%; 95% CI: 26% to 38%). Most participants had thoracolumbar (27%; 95% CI: 10% to 55%) and cervical injuries (23%; 95% CI: 16% to 31%), respectively. The incidence of TSCI was estimated at 10.5 per million people. The prevalence of TSCI was 3 per 10000 people. The mortality rate due to TSCI was 3.9% (95% CI: 0.02 to 0.06; P<0.05). Based on the findings of this meta-analysis, the pooled incidence and prevalence of TSCI in the Iranian population were 10.5/1000.000 people and 4.4/10.000 people, respectively. TSCIs had occurred more frequently in males following MVCs, and in the age group under 30 years. The pooled mortality rate due to TSCI was 3.9% (95% CI: 0.02 to 0.06; P<0.05).

Epidemiology of traumatic spinal cord injuries in Colombia.

Retrospective cohort study. To determine the incidence and characteristics of newly injured individuals admitted to a traumatic spinal cord injury (TSCI) referral center during a 4-year period. University Hospital of Valle, Cali, Colombia. Individuals were identified, and their data was recorded based on the International Spinal Cord Injury Core Data Set. The outcome of interest was the American Spinal Injury Association Impairment Scale (AIS) grade at the last follow-up. There were 491 individuals admitted in the 4-year period. The mean annual incidence of TSCI was 56.27 per million inhabitants. Considering TSCI in individuals exclusively from Cali, the mean annual incidence was 27.78 per million. The leading cause of TSCI was interpersonal violence (47.25%) and falls (33.60%). There was a strong correlation between AIS grade at admission and last follow-up. The most common AIS grade at the last follow-up was E (34.01%) caused mostly by falls (57.48%), followed by A (31.16%) caused mostly by interpersonal violence (76.27%). The reported employment rate dropped from 75.56% to 18.94% before and after TSCI (p < 0.05). AIS grade A was associated with more post-injury complications (p < 0.05). This is the first cohort study in Colombia describing the incidence and AIS grades of individuals with TSCI from a trauma referral center. Interpersonal violence was overrepresented in this population. Future research should include the evaluation of prevention strategies, as well as research on interventions towards quality improvement in patient care and post-discharge services especially for individuals with AIS grade A.

A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study

BackgroundTimely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 h from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement.MethodsThis record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged ≥16 years with incident TSCI in NSW (2013–2016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications.ResultsInclusion criteria identified 316 patients, geospatial analysis showed that over half (53%, n = 168) of all patients were injured within 60 min road travel of a SCIU, yet only 28.6% (n = 48) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma (p < 0.01) but higher ICISS (p < 0.001), cervical injury (p < 0.01), and transferred by air-ambulance (p < 0.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries (p < 0.01) or incomplete injury (p < 0.01). Patients not admitted to SCIU at all were older (p = 0.05) with lower levels of injury (p < 0.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p < 0.001). Complications included pressure injury, deep vein thrombosis, urinary infection, among others.ConclusionsGetting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. The higher rates of complication following delayed transfer to a SCIU should motivate health service policy makers to investigate reasons for this practice and consent to improvement strategies. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 min radius, enabling the benefits of specialised care.

Demographic and clinical characteristics of individuals with traumatic spinal cord injury in Argentina from 2015 to 2019: a multicenter study.

Descriptive and ambispective study. To describe the demographics, clinical characteristics, and etiologies of traumatic spinal cord injury (TSCI) in a metropolitan region of Argentina. Five inpatient rehabilitation centers in Buenos Aires, Argentina. We included all patients with acute TSCI who required hospital treatment at five rehabilitation facilities between 2015 and 2019. We collected data using portions of the International Spinal Cord Injury (SCI) Core Data Set. We registered 186 individuals as having TSCI. The males were 77% of the total sample. The mean age was 36 (SD ± 15.7) years. The distribution between paraplegia and tetraplegia was 50.3% and 49.7%, respectively. TSCI was complete in 57.3%. Including patients with motor complete SCI, the percentage reached 71.9% of the sample. Vehicular collisions were the leading cause of TSCI (47.3%), followed by falls (21.5%) and assaults (16.1%). We collected data about demographics, clinical characteristics, and aetiologies of TSCI for the first time in Argentina. The predominant demographic profile of the individuals with TSCI was of young males with complete SCI. We found the most important cause of TSCI was vehicular collisions. Implementation of road safety strategies in this target population might decrease the incidence of TSCI.

Epidemiology of traumatic spinal cord injury in Finland.

Study designProspective cohort study.ObjectivesTo determine the incidence and evaluate the characteristics of newly injured patients admitted to two spinal cord injury (SCI) centers during a 4-year period.SettingOulu and Tampere University Hospital, Finland.MethodsA dedicated multidisciplinary team evaluated all of the patients with new traumatic SCI (TSCI). The data were recorded according to the International Spinal Cord Injury Core Data Sets.ResultsIn a 4-year period, 346 new patients with TSCI were admitted to the study centers. In the Oulu and Tampere University Hospitals’ catchment areas, the mean annual incidence of TSCI was 36.6 per million. The leading causes of injury were low-level falls (36.2%), high-level falls (25.5%), and transport-related accidents (19.2%). In the patients >60 years, 72.6% were injured by falling and the proportion of low-level falls was 49.7%. In the patients ≤60 years old, 47.4% were alcohol-related. The proportion of cervical injuries in the patients >60 years was 77.1%, while in the patients ≤60 years the proportion was 59.6%. The incidence of TSCI was higher during the Summer and Autumn months.ConclusionThe mean annual incidence of TSCI was 36.6 per million corresponding to 200 new annual cases in Finland. Incomplete tetraplegia due to falling among elderly was overrepresented in the study population. Alcohol-consumption preceded injury in nearly half of the cases in the younger population. The prevention should focus on alcohol-related injuries and falls in the elderly.

A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018.

Retrospective epidemiological study. Since the causes and incidences of traumatic spinal cord injury (TSCI) in each country change over time, up-to-date epidemiological studies are required for countermeasures against TSCI. However, no nationwide survey in Japan has been conducted for about 30 years. The purpose of this study was therefore to investigate the recent incidence and characteristics of TSCI in Japan. Japan METHODS: Survey sheets were sent to all hospitals (emergency and acute care hospitals) that treated TSCI persons in Japan in 2018 and case notes were retrospectively reviewed. Frankel grade E cases were excluded from analysis. The response rate was 74.4% (2804 of 3771 hospitals). The estimated annual incidence of TSCI excluding Frankel E was 49 per million, with a median age of 70.0 years and individuals in their 70s as the largest age group. Male-to-female ratio was 3:1. Cervical cord injuries occurred in 88.1%. Frankel D was the most frequent grade (46.3%), followed by Frankel C (33.0%). The most frequent cause was fall on level surface (38.6%), followed by traffic accident (20.1%). The proportion of fall on level surface increased with age. TSCI due to sports was the most frequent cause in teenagers (43.2%). This nationwide survey in Japan showed that estimated incidence of TSCI, rate of cervical cord injury, and incomplete injury by falls appear to be increasing with the aging of the population.