Traumatic Spinal Cord Injury Cases Research Articles

Resident immune responses to spinal cord injury: role of astrocytes and microglia.

Spinal cord injury can be traumatic or non-traumatic in origin, with the latter rising in incidence and prevalence with the aging demographics of our society. Moreover, as the global population ages, individuals with co-existent degenerative spinal pathology comprise a growing number of traumatic spinal cord injury cases, especially involving the cervical spinal cord. This makes recovery and treatment approaches particularly challenging as age and comorbidities may limit regenerative capacity. For these reasons, it is critical to better understand the complex milieu of spinal cord injury lesion pathobiology and the ensuing inflammatory response. This review discusses microglia-specific purinergic and cytokine signaling pathways, as well as microglial modulation of synaptic stability and plasticity after injury. Further, we evaluate the role of astrocytes in neurotransmission and calcium signaling, as well as their border-forming response to neural lesions. Both the inflammatory and reparative roles of these cells have eluded our complete understanding and remain key therapeutic targets due to their extensive structural and functional roles in the nervous system. Recent advances have shed light on the roles of glia in neurotransmission and reparative injury responses that will change how interventions are directed. Understanding key processes and existing knowledge gaps will allow future research to effectively target these cells and harness their regenerative potential.

A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries.

Despite being relatively rare, pediatric traumatic spinal cord injury (TSCI) is a debilitating event with high morbidity and long-term damage and dependency. This study aims to provide insight on the epidemiological characteristics of pediatric TSCI worldwide. The studies were included if they provided data for the pediatric population with the diagnosis of TSCI. Information sources included PubMed, Embase, Web of Science, and Scopus. All databases were searched from 1990 to April 2023. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. The results of the meta-analysis were presented as forest plots. PROSPERO Registration code: CRD42020189757. We identified 87 studies from 18 developed and 11 developing countries. Of the 87 studies evaluated, 52 studies were considered medium quality, 27 studies were considered high quality, and 8 studies were considered low quality. In developed countries, the proportion of TSCIs occurring in patients aged 0-15 years was 3% (95% CI: 2.2%; 3.9%), while in developing countries, it was 4.5% (95% CI: 2.8%; 6.4%). In developed countries, the pooled incidence of pediatric TSCI was 4.3/millions of children aged 0-15/year (95% CI: 3.1; 6.0/millions children aged 0-15/year) and boys comprised 67% (95% CI: 63%; 70%) of cases. The most prevalent level of injury was cervical (50% [95% CI: 41%; 58%]). The frequency of SCI Without Obvious Radiological Abnormality (SCIWORA) was 35% (95% CI: 18%; 54%) among children 0-17 years. The most common etiology in developed countries was transport injuries (50% [95% CI: 42%; 57%]), while in developing countries falls were the leading cause (31% [95% CI: 20%; 42%]). The most important limitation of our study was the heterogeneity of studies in reporting age subgroups that hindered us from age-specific analyses. Conclusion: Our study provided accurate estimates for the epidemiology of pediatric TSCI. We observed a higher proportion of pediatric TSCI cases in developing countries compared to developed countries. Furthermore, we identified distinct epidemiological characteristics of pediatric TSCI when compared to adult cases and variations between developing and developed countries. Recognizing these unique features allows for the implementation of cost-effective preventive strategies aimed at reducing the incidence and burden of TSCI in children. What is Known: • Pediatric Traumatic Spinal Cord Injury (TSCI) can have profound physical and social consequences for affected children, their families, and society as a whole. • Epidemiological insights are vital for they provide the data and understanding needed to the identification of vulnerable populations, aiding in the development of targeted prevention strategies and effective resource allocation. What is New: • The estimated incidence of pediatric TSCI in developed countries is 4.3 cases per million children aged 0-15. The proportion of pediatric TSCI cases in relation to all-age TSCI cases is 3% in developed countries and 4.5% in developing countries. • The etiology of TSCI in pediatric cases differs between developing and developed countries. In developed countries, transport injuries are the most prevalent cause of pediatric TSCI, while falls are the least common cause. Conversely, in developing countries, falls are the leading cause of pediatric TSCI.

1216 Epidemiology, Management, and Outcome of Traumatic Spinal Cord Injury at Two Hospitals in the South-West Region of Cameroon: A Five-Year Retrospective Review

Abstract Aim To determine the prevalence, patterns, management, and outcome of traumatic spinal cord injury (TSCI) at the Buea Regional Hospital (BRH) and Limbe Regional Hospital (LRH). Method We performed a descriptive cross-sectional study with a retrospective data collection of cases of TSCI admitted from January 1st, 2017, to December 31st, 2021. Chi-square was used for bivariate analysis assessing correlation between various patterns and outcome of TSCI. The p-value was considered statistically significant if <0.05. Results TSCI represented 1% of hospital admissions. The majority were males (79.2%), and within the 25-44 years age group (55.6%). Referred patients represented 48.6% of cases. The most prevalent etiology was falls (43.7%). More than half (66.7%) had an incomplete SCI which correlated with the level of spine injury (p = 0.018). A spine CT scan was the neuroimaging modality of choice (65.3%). The treatment modalities varied, and the majority (92.3%) of those requiring surgery were operated on greater than 48 hours after injury. The morbidity rate was 36.1%, the severity of neurological injury improved in 23.6%, and the mortality rate was 16.9%. The level of spine injury and the initial severity of neurological injury correlated with the neurological outcome (p = 0.017; p = 0.007), and survival post-injury (p = 0.029; p = 0.006). Conclusions Males of the working age group are most at risk of TSCI. Most causes of TSCI at the are preventable, and their management deviates from recommendations. Their morbidity and mortality rates are high reflecting the realities of TSCI in sub-Saharan Africa.

Incidence and prevalence of traumatic spinal cord injury in Canada using health administrative data.

Incidence and prevalence data are needed for the planning, funding, delivery and evaluation of injury prevention and health care programs. The objective of this study was to estimate the Canadian traumatic spinal cord injury (TSCI) incidence, prevalence and trends over time using national-level health administrative data. ICD-10 CA codes were used to identify the cases for the hospital admission and discharge incidence rates of TSCI in Canada from 2005 to 2016. Provincial estimates were calculated using the location of the admitting facility. Age and sex-specific incidence rates were set to the 2015/2016 rates for the 2017 to 2019 estimates. Annual incidence rates were used as input for the prevalence model that applied annual survivorship rates derived from life expectancy data. For 2019, it was estimated that there were 1,199 cases (32.0 per million) of TSCI admitted to hospitals, with 123 (10% of admissions) in-hospital deaths and 1,076 people with TSCI (28.7 per million) were discharged in Canada. The estimated number of people living with TSCI was 30,239 (804/million); 15,533 (52%) with paraplegia and 14,706 (48%) with tetraplegia. Trends included an increase in the number of people injured each year from 874 to 1,199 incident cases (37%), an older average age at injury rising from 46.6 years to 54.3 years and a larger proportion over the age of 65 changing from 22 to 38%, during the 15-year time frame. This study provides a standard method for calculating the incidence and prevalence of TSCI in Canada using national-level health administrative data. The estimates are conservative based on the limitations of the data but represent a large Canadian sample over 15 years, which highlight national trends. An increasing number of TSCI cases among the elderly population due to falls reported in this study can inform health care planning, prevention strategies, and future research.

Five-Year Retrospective Study of the Prevalence and Outcome of Traumatic Spinal Cord Injury Cases in a Rural Tertiary Hospital.

Five-Year Retrospective Study of the Prevalence and Outcome of Traumatic Spinal Cord Injury Cases in a Rural Tertiary Hospital.

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.

Difficulties capturing co-occurring traumatic brain injury among people with traumatic spinal cord injury: a population-based study

Study designThis is a population-based prospective cohort study.ObjectivesTraumatic brain injury (TBI) is common among people with traumatic spinal cord injury (TSCI), but rates vary across studies associated with variable approaches to diagnosis. We aimed to determine if a published diagnostic algorithm could be consistently applied to capture co-occurring TBI among persons sustaining TSCI.SettingOne of two spinal centres in New Zealand (NZ), the Burwood Spinal Unit (BSU) captures approximately 45% of NZ TSCI admissions.MethodsAdults (age 16+) with TSCI admitted to the BSU between 1 January 2021 and 31 August 2021 (n = 51) were included. Clinical notes were audited prospectively to identify co-occurring TBI.ResultsWe identified co-occurring TBI in 39% of TSCI cases with a small number of additional suspected TBI cases where TBI could not be confidently ruled in or out. Including all TBI cases, suspected or otherwise resulted in up to 55% of the sample having sustained co-occurring TBI. There were difficulties applying the published algorithm, associated with inconsistent documentation of TBI indicators from acute to rehabilitation contexts.ConclusionsIn this study, the feasibility of a TBI diagnostic algorithm for the TSCI population was low. Alternative approaches to screening for TBI among people sustaining TSCI are needed. Greater consistency in documenting TBI across the continuum of care will ensure TBI if present, is included in treatment planning.

Differences in the Practice of Traumatic Spinal Cord Injury Management Among Spine Surgeons in Saudi Arabia.

This study aims to explore the ease of adopting clinical practice guidelines (CPGs) in managing traumatic spinal cord injury (TSCI) among spine surgeons, with particular focus on the use of steroids, high-dependency unit, early spinal cord decompression, and maintaining a target mean arterial blood pressure (MAP). We conducted a cross-sectional study among the practicing spinal surgeons in Saudi Arabia and included surgeons from neurosurgical and orthopedic backgrounds. The study period was from April to June 2020. The respondents provided sociodemographic data, training background, years of experience, and their clinical practices in managing TSCI via a survey tool constructed based on a literature review. The data were analyzed to evaluate the association between a surgeon's demographics and clinical practices. Ninety-eight spinal surgeons responded, comprising 40% of the practicing spine surgeon population in Saudi Arabia. The only area where the neurosurgical spine and orthopedic spine surgeons' practices differed significantly was maintaining MAP within a target range. Other differences between practices were not statistically significant. The authors also found a significant correlation between the surgeon's school of training and their experience concerning steroids administration. On the other hand, the surgeon experience and volume of treated TSCI cases correlated significantly with admission to a high-dependency unit. The adoption of CPGs remains a challenge to many spinal surgeons. Neurosurgeons are more into keeping the MAP at certain target, whereas the school of training and surgeon experience were the largest determinants of the surgeon's practice in managing TSCI in Saudi Arabia. As the variability in managment among spine surgeons remains a challenge, international and national spine societies are expected to build clinical practice guidelines from the limited existing literature.

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.

Upper Extremity Functional Improvements in Persons with SCI Resulted from Daily Utilization of Myoelectric Powered Wearable Orthotics.

Spinal cord injury (SCI) is a medically complex and life-disrupting condition. It is estimated that 17,700 new traumatic SCI cases are reported each year in the United States. Approximately half of those cases, involves paralysis, sensory loss, and impaired motor control in the upper extremity (UE) and lower extremities. Such impairments could affect the person's independence as well as their family members and caregiver. The limitation at the UE can significantly limit the general activities of daily living (ADL). The purpose of this paper is to determine the daily utilization effects on changing the handgrip AROM and handgrip forces before and after providing upper extremity in-clinic rehabilitation along with at-home utilization using an UE myoelectric powered wearable orthosis (UE-MPWO) in a person with incomplete spinal cord injury (iSCI). This device helps restore function to the weakened or paralyzed UE muscles. We demonstrate that the handgrip AROM and handgrip force improved after 6-weeks of training with the UE-MPWO. The overall goal of this study was to evaluate the effects of UE-MPWO (MyoPro) when utilized for in-clinic rehabilitation combined with at-home daily use in improving UE movement and function of people with iSCI.Clinical Relevance- The results of in-clinic rehabilitation combined with at-home daily utilization suggest that this UE-MPWO may improve UE function. The examined UE-MPWO could represent a relatively good example as a rehabilitation and assistive tool for persons with iSCI.

Pattern and outcome of traumatic spinal cord injury managed at University of Maiduguri Teaching Hospital, Nigeria: A retrospective study.

Understanding pattern and outcome of traumatic spinal cord injury (TSCI) will inform better management which expectedly would improve prognosis and minimise complications. : A retrospective study was carried out on all managed TSCI cases from January 2009 to December 2018. Sociodemographic characteristics, injury type, cause and complications were extracted from patients' registers and case folders. Descriptive statistics summarised the data, and Fisher's exact test analysed associations between variables. Eighty-one cases met the inclusion criteria and were analysed. Most cases (91.4%) were males, aged 18-39 years (65.4%) and were civil servants (37.0%). Road traffic accident (RTA) was the leading cause of injury (37.0%) and incomplete lesion predominated (69.1%). Cases referred for physiotherapy constituted 77.8%, only 14.8% of cases recovered without neurological deficits. On discharge, most patients were wheelchair bound (33.3%). Region of spine affected showed significant association with complications developed (P = 0.01). RTA caused more dead as a cause of injury was found to be significantly associated with outcome (P = 0.04). Referral for physiotherapy showed significant association with outcome (P = 0.01), so also, region of spine affected with outcome (0.01). The study found a significant association between type of injury and functional status (P = 0.01). : The study concludes that young adults of working class were mostly affected, and RTA and gunshots injuries were the leading causes of TSCI. Findings such as the association found between regions of spine affect and complication developed on admission will help healthcare providers identify those susceptible and offer prompt preventive measures.

Epidemiological characteristics of traumatic spinal cord injury in Xi'an, China.

A hospital-based retrospective epidemiological study. To describe the demographic and epidemiological characteristics of patients with traumatic spinal cord injury (TSCI) in Xi'an to help health-related institutions formulate corresponding measures. People with TSCI, all spine centres and orthopaedic centres in Xi'an, China. We retrospectively reviewed the medical records of the all spine centers or orthopedic centers in Xi'an according to the International Classification of Disease Version 10 (ICD-10) and diagnostic code of TSCI. Variables included gender, age, medical insurance, etiology, occupation, level of injury, and severity of injury, multiple injury, complication, treatment, and so on. The study included the medical records of 1730 patients with TSCI from 2014 to 2018. The estimated annual incidence rate increased from 39.0 cases (95% CI, 34.7-43.3 cases) per 1 million persons in 2014 to 43.2 cases (95% CI, 39.0-47.5 cases) per 1 million persons in 2018. The leading cause of TSCI was high falls (35.5%, 614 cases). The most common injury site was the cervical spinal cord, accounting for 55.7% (963 cases). The degree of injury severity with the highest proportion was incomplete tetraplegia (47.2%, 816 cases). In addition, 71.4% (1236 cases) of TSCI cases had spinal fracture or dislocation. There are specific epidemiological characteristics of TSCI patients in Xi'an, and preventive measures are suggested to be based on the characteristics of the different types of patients with TSCI and focused on high-risk groups.

Traumatic spinal cord injury in Victoria, 2007-2016.

To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10-year period. Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007-2016. Temporal trends in population-based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more). There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100000 population (95% CI, 1.17-1.36 per 100000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99-1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4-15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P<0.001). Overall in-hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths). Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post-discharge care, and support.

Economic impact of traumatic spinal cord injuries in the United States.

Individuals having sustained traumatic spinal cord injury (TSCI) in the United States are living longer as compared to historical trends, thanks to an ever-evolving understanding of the nature of this injury. Despite this, multiple barriers to care for TSCI patients remain including variations in government-issued veteran insurance, privatized insurance, and among uninsured individuals. The United States alone experiences 12,000 new TSCI cases every year, many of these are found to occur in a growing proportion of elderly individuals. It is crucial to understand both the short-term direct costs as wells as the long-term rehabilitation costs required by these TSCI patients. The lifetime financial burden for those having sustained a TSCI can be immense for patients, insurance companies, and hospital systems alike. Among those with TSCI, re-hospitalization rates are high, leading to increased healthcare resource utilization within this specific patient population. Costs can quickly balloon into hundreds of thousands of dollars and cause a profound financial burden for these patients. This review article seeks to communicate an understanding of the current financial landscape surrounding TSCI patients. The authors will also examine the costs of acute emergency room surgical care such as American spinal injury association grade, hospital length of stay, as well as the timing delay between injury and surgical decompression. Long-term costs associated with TSCI such as rehabilitation, care of secondary comorbidities, and post-injury employment prospects will be examined as well. These costs will be framed from the patient’s perspective as well as from both the hospital and insurance company’s perspectives. It is hoped a complete understanding as to what makes TSCI such a medically and financially burdensome injury will allow for improved healthcare resource utilization in this population.

Epidemiology of traumatic spinal cord injury in Tianjin, China: An 18-year retrospective study of 735 cases

Study Design: Hospital-based retrospective studyObjectives: To evaluate the pathogenetic features of traumatic spinal cord injury (TSCI) during 1999–2016 according to changed injury etiology with time, explore different characteristics of patients suffered a TSCI during 1999–2007 and 2008–2016 in Tianjin, China.Setting: Tianjin Medical University General HospitalMethods: In this study, the medical records of TSCI patients were obtained from Tianjin Medical University General Hospital (TMUGH) from 1st January 1999 to 31th December 2016. Variables were recorded, including age, gender occupation, etiology, the level of injury, America Spinal Injury Association (ASIA) impairment scale, the severity, concomitant injuries, death and its cause. To explore the differences in characteristics by etiology and by two periods, related statistical methods were used to calculate the correlation of some variables. Differences in etiology of TSCI during 1999–2016 were evaluated and differences in epidemiological characteristics were separately compared and analyzed between the 1999–2007 period and the 2008–2016 period.Results: From 1999–2016, 831 TSCI cases were identified and 96 cases were excluded from analyses. The male-to-female ratio was 2.9:1 and the mean age was 49.7±15.2 years, which changed significantly between 1999–2007 (45.1±14.2) and 2008–2016 (51.6±15.2). Traffic accidents (45.8%) were the leading cause of TSCI during the 1999–2007 period, followed by low falls (30.7%). However, the opposite result was observed during the 2008–2016 period. Significant difference was observed compared with thoracic, lumbar and sacral levels, cervical level was the most commonly affected levels and the percentage decreased to a certain degree between 1999–2007 and 2008–2016 (from 84.4% to 68.9%). The proportions of ASIA grades A, B, C, and D were 20.5%, 10.3%, 23.3%, and 45.9%, respectively. The percentage of complete tetraplegia decreased from 22.9% in 1999–2007 to 13.2% in 2008–2016, and the percentage of incomplete paraplegia increased from 9.7% to 27.9%.Conclusion: According to the changes in the epidemiological characteristics of TSCI, relevant health service, laws and regulations, preventative strategies should be readjusted to follow up the changing situation and epidemiological characteristics of TSCI.

Incidence of traumatic spinal cord injury in Italy during 2013-2014: a population-based study.

Observational prospective population-based incidence study. The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4-16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

The characteristics of traumatic spinal cord injuries at a referral hospital in Northern Tanzania.

Retrospective study. To describe the epidemiology of traumatic spinal cord injury (TSCI) in Northern Tanzania. Main referral hospital for Northern Tanzania. A retrospective review of 125 TSCI cases admitted to Kilimanjaro Christian Medical Centre (KCMC) over a period of 5 years. We included 125 patients in the sample size, with a male majority of 107 (85.6%), giving a male-to-female ratio of 5.9:1. The mean age at injury was 39.9 (±16.0) years. Overall, 66 (52.8%) were farmers and an overwhelming majority (109 (87.2%)) were referrals from peripheral medical centres. Fall injuries accounted for 65 (52.0%) of the admissions and 49 (39.2%) were injured due to a Road Traffic Accident (RTA). Severity of injury was classified according to the American Spinal Injury Association Impairment Scale (AIS) and 57 (45.6%) injuries were categorised as AIS A and 68 (54.4%) as AIS BCD. Cervical level injuries (59 (47.2%)) were the most frequent among the cohort. The in-hospital mortality rate was 24.1%. The majority of patients affected by TSCIs were young males and the most common cause was fall injuries. Cervical level injuries were the most common and in-hospital mortality was high.

Prehospital Predictors of Traumatic Spinal Cord Injury in Victoria, Australia

Objectives: To identify the predictors of traumatic spinal cord injury (TSCI) and describe the differences between confirmed and potential TSCI cases in the prehospital setting. Methods: A retrospective cohort study including all adult patients over a six-year period (2007–12) with potential TSCI who were attended and transported by Ambulance Victoria (AV). We extracted potential TSCI cases from the AV data warehouse and linked with the Victorian State Trauma Registry to compare with final hospital diagnosis. Results: We included a total of 106,059 patients with potential TSCI in the study, with 257 having a spinal cord injury confirmed at hospital (0.2%). The median [First and third Quartiles] age of confirmed TSCI cases was 49 [32–69] years, with males comprising 84.1%. Confirmed TSCI were mainly due to falls (44.8%) and traffic incidents (40.5%). AV spinal care guidelines had a sensitivity of 100% to detect confirmed TSCI. There were several factors associated with a diagnosis of TSCI. These were meeting AV Potential Major Trauma criteria, male gender, presence of neurological deficit, presence of an altered state of consciousness, high falls (> 3 meters), diving, or motorcycle or bicycle collisions. Conclusion: This study identified several predictors of TSCI including meeting AV Potential Major Trauma criteria, male gender, presence of neurological deficit, presence of an altered state of consciousness, high falls (> 3 meters), diving, or motorcycle or bicycle collisions. Most of these predictors are included in NEXUS and/or CCR criteria, however, Potential Major Trauma criteria have not previously been linked to the presence of TSCI. Therefore, Emergency Medical Systems are encouraged to integrate similar Potential Major Trauma criteria into their guidelines and protocols to further improve the provider's accuracy in identifying TSCI and to be more selective in their spinal immobilization, thereby reducing unwarranted adverse effects of this practice.

Traumatic spinal cord injury in the north-east Tanzania – describing incidence, etiology and clinical outcomes retrospectively

ABSTRACT Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting. Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively. Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most documented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%. Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed.

Changing demographics of spinal cord injury over a 20-year period: a longitudinal population-based study in Scotland.

Study design:A retrospective cohort study.Objectives:To review demographic trends in traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI).Setting:The Queen Elizabeth National Spinal Injuries Unit (QENSIU), sole provider of treatment for TSCI in Scotland; a devolved region of the UK National Health Service.Methods:A retrospective review of the QENSIU database was performed between 1994 and 2013. This database includes demographic and clinical data from all new TSCI patients in Scotland, as well as patients with severe NTSCI.Results:Over this 20-year period there were 1638 new cases of TSCI in Scotland; 75.2% occurring in males. TSCI incidence increased non-significantly (13.3 per million population to 17.0), while there were significant increases in mean age at time of TSCI (44.1–52.6 years), the proportion of TSCIs caused by falls (41–60%), the proportion of TSCIs resulting in an American Spinal Injury Association Impairment Scale score of C and D on admission (19.7–28.6% and 34.5–39.5%, respectively) and the proportion of cervical TSCIs (58.4–66.3%). The increase in cervical TSCI was specifically due to an increase in C1–C4 lesions (21.7–31.2%). NTSCI patients (n=292) were 5 years older at injury, more likely to be female (68.1% male) and had a range of diagnoses.Conclusion:This study supports the suggestion that demographic profiles in SCI are subject to change. In this population, of particular concern is the increasing number of older patients and those with high level tetraplegia, due to their increased care needs. Prevention programmes, treatment pathways and service provision need to be adjusted for optimum impact, improved outcome and long-term care for their target population.