National Spinal Cord Injury Database Research Articles

Aging with spinal cord injury: Changes in selected health indices and life satisfaction

Charlifue S, Lammertse DP, Adkins RH. Aging with spinal cord injury: changes in selected health indices and life satisfaction. Arch Phys Med Rehabil 2004;85:1848-53. Objectives To document the impact of age, age at injury, years postinjury, and injury severity on changes over time in selected physical and psychosocial outcomes of people aging with spinal cord injury (SCI), and to identify the best predictors of these outcomes. Design Retrospective cross-sectional and longitudinal examination of people with SCI. Setting Follow-up of people who received initial rehabilitation in a regional Model Spinal Cord Injury System. Participants People who meet the inclusion criteria for the National Spinal Cord Injury Database were studied at 5, 10, 15, 20, and 25 years postinjury. Interventions Not applicable. Main outcome measures Number of pressure ulcers, number of times rehospitalized, number of days rehospitalized, perceived health status, satisfaction with life, and pain during the most recent follow-up year. Results The number of days rehospitalized and frequency of rehospitalizations decreased and the number of pressure ulcers increased as time passed. For the variables of pressure ulcers, poor perceived health, the perception of pain and lower life satisfaction, the best predictor of each outcome was the previous existence or poor rating of that same outcome. Conclusions Common complications of SCI often herald the recurrence of those same complications at a later point in time, highlighting the importance of early intervention to prevent future health and psychosocial difficulties.

Predictors of personal care assistance for people with spinal cord injury

Weitzenkamp DA, Whiteneck GG, Lammertse DP. Predictors of personal care assistance for people with spinal cord injury. Arch Phys Med Rehabil 2002;83:1399-405. Objective: To assess the predictors of personal care assistance (PCA) use in people with spinal cord injury (SCI). Design: Cross-sectional. Setting: Follow-up of individuals crossing their 1st, 5th, 10th, 15th, 20th, or 25th anniversary of injury who underwent their initial rehabilitation at a Spinal Cord Injury Model Systems center. Participants: A total of 2154 participants (2547 records) who met the inclusion criteria for the National Spinal Cord Injury Database and had valid values for the main outcome measures. Interventions: Not applicable. Main Outcome Measures: Daily hours of paid, unpaid, and occasional PCA services. Results: Differences in an interval version of the motor portion of the FIM™ instrument accounted for 26.3% of the variance in total PCA hours, Model Systems differences accounted for 9.3%, and no other predictor accounted for more than 2.1% of the variance. Conclusion: Activities of daily living functioning, as measured by the motor portion of the FIM, was the strongest predictor of PCA use among people with SCI. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Epidemiology of extraspinal fractures associated with acute spinal cord injury.

A descriptive study of concurrent extraspinal fractures collected prospectively during initial hospital care. To examine the frequency and related characteristics of concurrent extraspinal fractures among patients with a new onset of spinal cord injury (SCI). Model SCI care systems throughout the United States. A consecutive sample of 5711 subjects admitted to the National SCI Database between 1986-1995 was recruited to estimate the incidence of extraspinal fractures associated with acute SCI, stratified by anatomic sites, demographics, and injury related characteristics. Of 5711 subjects, 1585 (28%) patients had extraspinal fractures; 580 (37%) patients had more than one fracture site. The most common region of fractures was chest, followed by lower extremity, upper extremity, head, others, and pelvis. The overall incidence rate was higher for women than men, for whites than non-whites, for paraplegics than tetraplegics, and for those injured in motor vehicle crashes than others. Compared with patients having single fracture, those who had multiple fractures were likely to be white, paraplegic, and injured in motor vehicle crashes. There was no age difference in the incidence of concurrent fractures, single or multiple. Extraspinal fractures are not uncommon at the same time as SCI. The fracture occurrence varies by gender, race, injury level, and etiology of injury. The knowledge of these associated factors will aid in early recognition of fractures, preventing complications, and facilitating rapid mobilization and rehabilitation outcomes among persons with SCI.

GEOGRAPHIC VARIATION AND ENVIRONMENTAL RISK FACTORS FOR THE INCIDENCE OF INITIAL KIDNEY STONES IN PATIENTS WITH SPINAL CORD INJURY

Although geographic variability in cases of kidney stones, primarily calcium stones, is reported in the general population, little is known about geographic variability in subjects with spinal cord injury, in whom struvite stones predominate. We examined regional variation in the incidence rate of initial kidney stones and clarified the contributing factors in a spinal cord injury cohort. We used data from the national spinal cord injury database between 1986 and 1999 on 7,784 participants from 21 spinal cord injury centers with 24,492 person-years of followup accumulated and 286 incident stone cases. A multilevel Poisson model was constructed to evaluate the ecological effects of latitude, air temperature, water hardness and sunlight index on stone formation while controlling for individual factors, including participant age, race, gender, severity of injury and bladder management. The incidence rate was significantly greater in the southeast and tended to increase with decreasing latitude, similar to the geographic association with kidney stones in the general population. This finding was not explained by differences in individual risk factors. Decreasing water hardness had the strongest effect on stones during year 1 after injury (relative risk 0.6, p <0. 001), whereas average annual temperature had the strongest association with stones after year 1 (relative risk 1.1 per 1C increase, p = 0.03). The sunlight index had no association. Our study implies that the increased stone risk in spinal cord injured subjects is potentially preventable by modifying environmental exposure. Etiological factors may be similar to those for kidney stones in the general population.

A Comparative Study Of Outcomes And Expenses Following Tetraplegia And Paraplegia

Objective: A study was designed to directly compare individuals with tetraplegia and paraplegia to further explore neurological and functional outcomes and their impact on theexpense of rehabilitation when controlling for level of completeness, age at the time ofinjury, and length of stay.Methods: A sample was drawn from the National Spinal Cord Injury Database consisting of 2069 individuals, 1005 with paraplegia and 1064 with tetraplegia.Results: Significant demographic differences were found between the 2 groups with regard to age, ethnicity, marital status, and employment status. Significant differences werefound between the groups withregard to all individual outcome variables (p<.001) and expenses (p<.05). On average,patients with paraplegic injuries evidenced greater change and efficiency on a functionalindependence measure than patients with tetraplegia. In contrast, patients with tetraplegia showed greater changes and efficiency with regard to ASIAMotor Index scores. Higherrehabilitation expenses were found for patients with tetraplegia.

History, implementation, and current status of the national spinal cord injury database

Objective: To summarize a 25-year history of the Model Spinal Cord Injury Program and the coexistent National Spinal Cord Injury Database and provide the status of the Database with a discussion of the strengths and weaknesses. Design: Inception cohort. Setting: Model spinal cord injury systems throughout the United States. Results: As of September 1998, the National Spinal Cord Injury Database included abbreviated registry records on 6,085 new patients, more complete initial injury and hospitalization records on 18,969 new patients, and 78,627 annual follow up records on those persons. Although stability and continuity of the Database has been a priority since it was started, some changes were needed to meet the changes in health care, health care policy, and new technology. Conclusion: This large database can now provide a wealth of information about short- and long-term outcomes, provide data on which future health care policies can be evaluated, and act as a source for answers to future research questions.

Predicting community reintegration after spinal cord injury from demographic and injury characteristics

Objective: To determine the influence of demographic and injury characteristics on the community reintegration of people with spinal cord injury (SCI). Design: Prospective cross-sectional and longitudinal examination of individuals with SCI. Setting: Follow-up of individuals at 1, 2, 5, 10, 15, and 20 years after SCI who received their initial rehabilitation in a Regional Model Spinal Cord Injury System. Participants: A total of 3,835 individuals who met the inclusion criteria for the National SCI Database were studied cross-sectionally, and a subset of 347 individuals who were also enrolled in a longitudinal study of aging with SCI. Main Outcome Measures: Subscales of the Craig Handicap Assessment and Reporting Technique (CHART). Results: Neurologic classification, age, years postinjury, gender, ethnicity, and education explain 29% of the variance in physical independence, 29% of the variance in mobility, 28% of the variance in occupation, 9% of the variance in social integration, and 18% of the variance in economic self-sufficiency. Conclusions: Although these factors are inadequate to explain most of the variation in community reintegration (handicap) after SCI, they might appropriately be used to adjust for case-mix differences when comparing rehabilitation facilities and techniques.

Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being

Objective: To specify the degree to which current age, duration of injury, and neurologic status affect the frequency of secondary health and psychosocial conditions in persons with long-term spinal cord injury (SCI), using both longitudinal and cross-sectional analysis techniques. Design: Prospective longitudinal examination and data collection involving individuals with SCI studied initially at their 5th, 10th, and 15th anniversaries postinjury, and subsequently 5 years later at their 10th, 15th, and 20th anniversaries postinjury. Setting: Five Regional Model Spinal Cord Injury Systems. Participants: The 439 individuals who meet the inclusion criteria for the National SCI Database and who are enrolled in a longitudinal study of secondary conditions and SCI. Main Outcome Measures: Physical and psychosocial status at various times postinjury. Results: There are different reports of various conditions when analyzing by neurologic groups, duration of injury, and age. Cross-sectional and longitudinal analyses also demonstrate different patterns of complications. Conclusions: The longitudinal method, like cross-sectional research, allows for identification of physical and psychosocial changes soon after they occur. Longitudinal research, however, also makes possible the development of predictive models for various long-term outcomes.

Spinal Cord Injury Caused by Interpersonal Violence: Epidemiologic Data from the National Spinal Cord Injury Database

It has been asserted that interpersonal violence is the cause of increasing numbers of spinal cord injuries (SCIs). Data from the National Spinal Cord Injury Database (NSCID) maintained by the SCI Model Systems were examined to analyze the frequency and correlates of SCI caused by violence. Of 23,534 cases entered into the NSCID since 1973, 4,445 (18.9%) were injured as a result of violence (ie, gunshots, other penetrating injury, assaults). Compared with those injured as a result of other causes (ie, motor vehicle accident, sports, fall, being hit by falling objects, other), those injured as a result of violence are more frequently male, young, and of a minority background. They also are more likely to be unemployed, have a limited education, and be single at onset of injury. The percentage of SCIs resulting from violence increased from 13.8% of the total in 1973-1977 to 23.8% in 1993-1997. The increase was limited to Hispanics and blacks, males, homemakers and the unemployed, and persons between the age...

Physical Rehabilitation and Violence: Initiatives of the National Institute on Disability and Rehabilitation Research

The paper presents an analysis of violence-related data from the National Spinal Cord Injury Database within the context of violence-related projects of the U.S. Department of Education's Office of Special Education and Rehabilitative Services. The National Spinal Cord Injury Database is managed by the Spain Rehabilitation Center at the University of Alabama at Birmingham, which is one of 13 Model Spinal Cord Injury Care System centers funded under a grant from the U.S. Department of Education's Institute on Disability and Rehabilitation Research. There are 1,732 cases of spinal cord injury (SCI) due to violence enrolled in the database. This enrollment provides a longitudinal sample, an analysis of which shows that African American individuals and persons of Hispanic origin represent an increasing percentage of new cases, and that an increasing percentage of individuals within these populations is incurring SCI as a result of violence.