Epidemiology of Traumatic SCI
Falls
There were 82 studies reporting data on falls leading to SCI (Table 8). 40 studies used data arising from hospital admission/discharge records which included either single or multiple hospitals. A total of 14 studies were based on national data from specifically designed SCI databases. Most of the studies were conducted in North America (Canada N=8; United States N=18) and Europe (N=24) followed by studies conducted in countries in Asia (N=20), Africa (N=5), Oceania (N=6), and South America (N=1).
The proportion of fall-related SCI ranged from a low of 2.2% in Italy (Caldana and Lucca 1998) to a high of 77.6% in Nepal (Lakhey et al. 2005). Interestingly a large proportion of the high rate of falls reported in Nepal is due to the occupational hazard of working in trees. The most commonly reported proportion of fall-related SCI was in the 20-30% range (N=27 studies) followed by the range below 20% (N=16). One likely source of variation is due to the included age groups. Samples that included all age groups tended to have a lower proportion of fall-related SCI compared to those with older adults. Studies from Japan (Shingu et al. 1995; Shingu et al. 1994) and Romania (Soopramanien et al. 1994) had higher proportions of fall-related SCI compared to other countries. The mean age of subjects in these studies tended to be older (about 40 years or more) than in the other studies.
Most recent estimates from the United States indicate falls as the second leading cause of SCI, varying from 24.5% to 27.3% (National Spinal Cord Injury Statistical Center February 2010; DeVivo and Chen 2011), and the leading cause of SCI among individuals 45 years of age and older (DeVivo and Chen 2011). In 3 studies from Canada, falls were the leading cause of SCI in one study (49.5%) (Couris et al. 2010), and the second leading cause in the other studies (16.4%; 21.2%; 28.5%) (Pirouzmand 2010; McCammon and Ethans 2011; Lenehan et al. 2012). In the Couris et al. (2010) study, falls were likely the leading cause of SCI because of the sample selection was of an adult population (mean age = 51.3 years), which is consistent with other studies from North America reporting SCIs due to falls are most prevalent among older individuals.
In Europe, falls have recently been reported as either the leading cause of SCI (45.5% in regions of Norway, 41.0% in Estonia) (Hagen et al. 2012; Sabre et al. 2012) or the second leading cause (33.9% in Turkey, 24.6% in Spain, 30.9% in Iceland) (Cosar et al. 2010; Van Den Berg et al. 2011; Knutsdottir et al. 2012). Similar to reports from North America, three European studies reported falls as the most common cause of SCI among elderly individuals.
In Asia, 5 studies reported falls to be the leading cause of SCI (Qureshi et al. 2010; Ning et al. 2011; Li et al. 2011; Wu et al. 2012; Wang et al. 2013), and 5 studies reported falls as the second leading cause (Chabok et al. 2009; Wu et al. 2011; Chhabra and Arora 2012; Ibrahim et al. 2013; Hua et al. 2013). Whereas SCI due to falls is primarily reported among older individuals in North America and Europe, falls leading to SCI in Asia are a combination of low falls among older individuals and falls from heights among working age individuals in the construction industry (Li et al. 2011). Interestingly, in a recent review, Chiu et al. (2010) identified falls from heights to be the leading cause of SCI in developing countries.
| Author Year N of study population |
Geographic region |
Inclusion/ exclusion criteria |
Study
population |
Injury features | Cause: %(n of
cases) |
|---|---|---|---|---|---|
| Hua et al. 2013 N=561 |
China | Retrospective review of individuals who were treated at The General Hospital of Chinese People’s Armed Police Forces |
Males = 79.9% Mean Age = 31.85 years |
Fall Specific: Incomplete: 47.7% Cervical (45.5%) Cervical-Thor (2.2%) Thoracic (33.6%) Thor-Lumbar (8.2%) Lumbo-sacral (10.4%) |
23.9% |
| Ibrahim et al. 2013 N=292 (traumatic and non)` |
Kuala Lumpur, Malaysia |
2006-2009 Admitted to the Department of Rehabilitation Medicine, Hospital Kuala Lumpur |
Males = 77% Mean age = 39 year |
Tetraplegia: 37% (108) Paraplegia: 63% (180) |
Traumatic: Falls 28 % |
| Wang et al. 2013 N=761 |
Anhui Province, China |
All patients admitted to two hospitals within Anhui Province, China between January 2007 and December 2010 |
Males = 77.3% Mean age = 45 years |
Cervical (46.3%) Thoracic (20.4%) Lumbrosacral (33.3%) |
Fall: 52.6% Low Fall: 12.7% |
| Alshahri et al. 2012 N=307 |
Riyadh, Saudi Arabia |
2003 to 2008 Traumatic SCI, admitted to Riyadh Military Hospital in Saudi Arabia |
Males = 88% Mean age=29.5 years |
Complete tetra = 21% Incomplete tetra = 31% Complete para = 29% Incomplete para = 18% |
Fall: 9.1% (n=28) |
| Chhabra and Arora 2012 N=1138 |
India | All patients admitted to an Indian Spinal Injuries Centre 2002 to 2010. |
85.5% males Mean age: 34.4 years |
AIS A: 71.1% AIS B: 14.7% AIS C:8.2% AIS D: 6.0% |
Fall from height: 39.6% |
| Knutsdottir 2012 N=207 |
Iceland | 1975-2009 Patients admitted to Landspitali University Hospital |
Males: 72% Mean Age: 38 years |
Cervical: 57% Thoracic/Lumbar: 43% |
Falls: 30.9% |
| Lenehan et al. 2012 N=930 |
British Columbia, Canada |
1995-2004 Hospital admissions to level 1 trauma center were prospectively collected using a locally designed spine database |
Males = 80% Median: 35 years |
Cervical: 45.1% Thoracic: 24.5% L/S: 20.9% Unspecified: 9.5% |
Fall: 28.5% |
| Middleton et al. 2012 N=324 |
New South Wales, Australia |
January 2004 to June 2008, Data from Ambulance Service of New South Wales |
Males = 85% Mean age = 42 years |
Not Specified | High fall: 18.8%% Low fall: 10.8% |
| Sabre et al. 2012 N=595 |
Estonia | 1997-2007 SCI patients admitted to any Estonia hospitals |
Male:Female = 5.5:1 Average age of injury = 39.0 years |
C1-C4, AIS, A, B, C = 9.9% C5-C8, AIS, A, B, C = 28.9% T1-S5, AIS , A, B, C = 26.7% All AIS D = 23.9% Unknown = 10.6% |
Falls: 41.0% |
| Wu et al. 2012 N=143 |
Tianjin, China |
Patients admitted to Tianjin Medical University General hospital with diagnosis of tSCI |
Mean age 54.6 years Male:Female = 5:1 |
ASIA A = 5.6% ASIA B = 16.8% ASIA C = 18.9% ASIA D = 58.7% |
Low fall = 45.5% High fall = 4.2% |
| Devivo et al 2011 N=45,442 |
USA | 1935-2008 Persons who were treated at either a SCI Model System or a Shriners Hospital SCI unit |
Males= 79.2% Mean age at injury= 32.5 years |
19.8% C1-4 32.6% C 5-8 45.4% Paraplegic 2.2% Normal |
Falls: 24.5% (n=11,133) |
| Li et al. 2011 # of patients: N=1079 data collected: N=264 |
Beijing, China |
Patients with acute TSCI admitted to civilian or military hospitals during Jan 1- Dec 31 2002 |
200 male (76%) Mean age: 41.7 years Range: 6-80 years |
Cervical (4.9%) Thoracic (28%) Thoracolumbar, lumbar and lumbosacral (66%) |
Falls: (41.3%) n=109 |
| McCammon and Ethans 2011 N=553 |
Manitoba, Canada |
1981-1985, 1998- 2002, 2003-2007 Inclusion criteria: survival to hospital admission with TSCI, or outpatient referral to an SCI rehabilitation specialist. Exclusion criteria: congenital causes of paralysis such as spina bifida or cerebral palsy as well as acquired paralysis from multiple sclerosis or Guillan-Barre syndrome. |
75.8% male Mean Age: 1981-1985: 29.0 years 1998-2002: 35.3 years 2003-2007: 39.8 years |
1981-1985: Cervical: 46.2% Thoracic:33.0% Lumbar: 20.9% Sacral:0.0% 1998-2002: Cervical:45.0% Thoracic:33.3% Lumbar: 21.6% Sacral:0.0% 2003-2007: Cervical:51.3% Thoracic:34.9% Lumbar:12.5% Sacral:1.3% |
Falls: 81-85: 14.5% 98-02: 16.1% 03-07: 16.4% |
| Ning et al. 2011 N=869 |
Tianjin, China |
All patients with TSCI aged 15 or older admitted to tertiary hospitals in Tianjin from Jan 1, 2004- Dec 31, 2008 |
738 male (84.9%) Mean age (sd) 46.0 (14.2) |
Cervical (71.5%) Thoracic (13.3%) Lumbar (15.1%) Sacral (0.1%) |
Falls: Low fall: (37.6%) n=327 High fall: (19.3%) n=168 |
| Van Den Berg et al. 2011 N=540 |
Aragon, Spain |
Hospitalized from January 1972 to December 2008 for traumatic SCI and received medical care in Aragon following the acute stabilization period, regardless of place of injury and acute care. |
79% male, mean age 39.6±17.7 yrs |
36.9% (n=199) cervical 37.4% (n=202) thoracic 19.3% (n=104) lumbar 4.3% (n=23) sacral |
Falls (24.6%) |
| Wu et al. 2011 N=41,586 |
Taiwan | All SCI patients older than 20 years of age and admitted to medical services from 1998-2008 that were identified using the National Health Insurance Research Database of Taiwan. |
62% male (n=25857) 61.2% had traumatic SCI (n=25,439) |
Cervical: 51.8% N=21,557 Thoracic: 12.3% N=5,098 Lumbar: 22.9% N=9,533 Other SCI: 13.0% N=5,398 |
Falls: (34.8%) n=8,851 calculated using N traumatic SCI= 25,439) |
| Cosar et al. 2010 N TSCI=127 |
Turkey | Patients with traumatic SCI who participated in an in-patient rehabilitation program at a tertiary research hospital from 1996- 2008. |
67.7% (n=86) male mean age 37.81±13.65 years |
36 (28.3%)-tetraplegic (C4-T1) 76 (59.8%)-paraplegic (T2–T12) 15 (11.8%) had conus– cauda equina (L1–S4) injury |
Falls; (33.9%) |
| Couris et al. 2010 N=936 |
Ontario, Canada |
The study included all patients aged 18 years or older living in Ontario during the fiscal years 2003– 2004 (through 2006– 2007) who experienced TSCI. |
74.1% (n=694) male mean age: 51.3±20.1 years |
65.5% (n=610) cervical 21.3% (n=198) thoracic 10.0% (n=93) lumbar 3.2% (n=30) other |
Falls: (49.5%) n=463 |
| Hagen et al. 2010 N=336 |
Norway (2 counties: Hordaland and Sogn og Fjordane) |
Patients who suffered a TSCI from 1952- 2001 and lived in Hordaland or Sogn og Fjordane |
Male to female ratio was 4:7:1 % of women varied from 6.9- 24.4% |
Complete (41.4%) Incomplete (58.6%) Cervical (52.4%) Thoracic (29.5%) Lumbar/sacral (18.2%) |
Falls: (45.5%) n=153 <1m: 11% 1-5m: 23.2% >5m: 11.6% |
| NSCISC 2010 N=26852 |
USA | 1973-2009 26 federally funded Model SCI Care Systems and National SCI Database |
ColuMale= 80.8% (1973-2009) Mean age at injury = 40.2 years (2005- 2009) |
2005-2009 Tetraplegia = 55.2% Paraplegia = 44.4 % Complete Tetraplegia = 16.9% Incomplete tetraplegia = 38.3% Complete Paraplegia = 22.9% Incomplete Paraplegia = 21.5% |
Falls: 27.3% (n=7331) |
| Pirouzmand 2010 N=12,192 |
Toronto, Canada |
1986-2006 SCI and SI in Sunnybrook Trauma Registry Database |
[SI Male=66% Median age=36 years] SCI Male= 76% Median age=33 years CSCI Median age= 30 years |
[Spinal Injury= 23.2% -Cervical= 29% – Thoracic= 21% – Lumbosacral= 50%] SCI= 5.4% – Cervical=29% – Thoracic=21% – Lumbo-sacral = 50% – Multiple Levels= 20% CSCI=3% |
Falls: 21.2% |
| Qureshi et al. 2010 N=521 |
Rawalpindi, Pakistan |
All patients who suffered a spinal injury from non-disaster causes and were admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. |
402 male (77%) Mean age (sd) 39.1 (16.17) |
Level of injury: Thoraco-lumbar spine (n=369, 71%), lower cervical spine (n=93, 18%), upper cervical spine (n=42, 8%) and sacrum (n=9, 2%). Injuries at multiple levels in 8 (2%) |
Fall from height: (62%) n=323 |
| Chabok et al. 2009 N=245 |
Guilan, Iran |
Patients admitted to Poursina Hospital, with TSCI |
71.8% male | Neurological status: 15 complete 29 incomplete 201 no neurological damage cervical- n=17 thoracic- n=6 thoracolumbar- n=48 Lumbar= 12 |
Falls: (43.3%) N=106 |
| Obalum et al. 2009 N=468 |
Lagos, Nigeria |
1992-2006 Registrars at the emergency room and wards from the Lagos University Teaching Hospital (receives the majority of SCI patients in Lagos) |
Male=70.1% 66.2% were ages 40 years and below. Peak age incidence = 21-30 years. |
ASIA A n=230 ASIA B n=45 ASIA C n=36 ASIA D n=41 ASIA E n= 34 Death n=82 Lumbar n=278 Cervical n=142 Thoracic n=48 |
Falls: 9.4% (n=44) |
| Ahoniemi et al. 2008 N=1647 |
Finland | 1976-2005 Register survey; Medical records from registers of Käpylä Rehabilitation Centre |
83% male Mean age of injury (M/F): 1976-1985: 34.7/35.8 1986-1995: 36.7/38.3 1996-2005: 42.4/40.4 |
50.6% tetraplegia 49.4% paraplegia |
Falls: 41.2% (n=678) |
| Macciocchi et al. 2008 N= 298 |
Southeastern, USA |
2004-2005 All patients admitted for traumatic SCI between the ages 16- 59. Excluded if unable to speak English |
Male=79% Mean age =28.7±10.1 years.74% of all eligible patients. |
C1-4 ASIA A-C, n=9 C1-4 ASIA D, n=5 C5-8 ASIA A-C, n=30 C5-8 ASIA D, n=6 T1-8 ASIA A-C, n=26 T1-8 ASIA D, n=2 T9-12 ASIA A-C,n=15 T9-12ASIA D, n=3 L1-S3 ASIA A-C, n=5 |
Falls: 10% (n=30) |
| National Spinal Cord Injury Statistical Center 2008 N=25,415 |
USA | 26 federally funded Model SCI Care Systems and National SCI Database |
77.8% male (2000-2008) Average age = 39.5 years (2005- 2008) |
2000-2008 Incomplete tetraplegia: 34.1% Complete paraplegia: 23.0% Complete tetraplegia:18.3% Incomplete paraplegia: 18.5% |
Falls: 27.1% (n=6887) |
| Fassett et al. 2007 N=412 |
Philadelphia, Pennsylvania, USA |
1978-2005 Treated in Delaware Valley Regional Spinal Cord Injury Center at Thomas Jefferson University Hospital |
≥70 years old. No further demographics given. |
High quadriplegic (C4 and above)=42% Paraplegic=22% ASIA A ~ 45% ASIA B ~ 13% ASIA C ~ 15% ASIA D ~ 24% |
Falls: 74% (n=305) |
| Shrestha et al. 2007 N=149 |
Eastern region, Nepal |
2001-2004 Admission to hospital in Dharan with cervical spinal injury |
Males=80% Mean age=40 (6- 88) years Mortality=6 (4%) |
Frankel levels: A=54 (36%) B=20 (13%) C=22 (15%) D=19 (13%) E=34 (23%) |
Falls: 60.4% (n=90) |
| Pickett et al 2006 N=151 |
London, Ontario, Canada |
1997-2006 Admissions to hospital in London, Ontario with SCI |
Male=74.2% Mean age = 42.2 ± 20.9 (9-96) years Mortality=12 (8%) |
Cervical=75% Thoracic= 10% Lumbar=9% Junctional=6% Complete=35% Incomplete=65% |
Falls: 31.1% (n=47) |
| Calancie et al. 2005 N=229 |
Dade County, Florida, USA |
Acute traumatic spine and/or spinal cord injury admitted to Jackson Memorial Hospital |
Male = 74.6% Average age at injury=40.0±17.5 years 15 were children |
ASIA A = 32.8% (75) ASIA B = 4.8% (11) ASIA C = 24.0% (55) ASIA D = 31.5% (72) ASIA E = 7.0% (7.4) Fractures: Cervical = 62% T1-T10 = 15% (35) T11-L4 = 19% (44) Non-fractures: Cervical = 3% (7) Complete = 32.8% |
Falls: 19.7% (n=45) |
| Dahlberg et al. 2005 N=152 |
Helsinki, Finland |
January 1, 1999 cross-section date Adult citizens (18 years or more) of Helsinki who had permanent sensory or motor deficits because of traumatic SCI (ASIA A–D). ASIA-E cases were excluded. |
Males = 76% Average age of injury=47.9 years |
Data only for 121 subjects: 46% (n=56) tetraplegia 54% (n=65) paraplegia 57% (n=69) incomplete 43% (n=52) complete |
Falls: 43% (n=66) |
| Gur et al. 2005 N=539 |
Southeastern Anatolia, Turkey |
1990-1999 4 hospitals that were major referral centers for trauma |
Average age of injury=30.62 (1- 70) years 77.2% (n=416) male 22.6% (n=120) civil servants 20.2% (n=109) housewives 15.0% (n=79) soldiers |
29.3% (n=158) incomplete paraplegia 45.1% (n=243) complete paraplegia 13.7% (n=74) incomplete tetraplegia 13.9% (n=75) complete tetraplegia 25.4% (n=137) cervical 36.7% (n=198) thoracic 34.0% (n=183) lumbar |
Falls: 31.9% (n=172) |
| Lakhey et al. 2005 N=233 |
Dharan, Nepal |
May 1997- April 2001 Orthopaedic ward of BP Koirala Institute of Health Schiences |
Male=72.5% <20years old=26 individuals (11.1%), 20-30yrs=59 (25.3%), 31-40yrs=49 (21.0%), 41-50yrs=37 (15.9%), >50yrs=62 (26.6%) | cervical = 88 (37.8%) dorsal = 70 (30.0%) lumbar = 72 (30.9%) none bony = 3 (1.3%) complete = 46.8% |
Falls: 77.6% (n=181) from trees: 40.3% (n=94) 1 st/2nd floor: 27.9% (n=65) Hill slope: 4.7%(n=11) Ladder: 4.7% (n=11) |
| National Spinal Cord Injury Statistical Center 2005 N=23,683 |
USA | 25 federally funded Model SCI Care Systems and National SCI Database |
Male=79.6% Average age of injury=37.6 years 62.9% Caucasian 22% African American 12.6% Hispanic 51.8% single |
Incomplete tetraplegia (34.5%) Complete tetraplegia (18.4%) Incomplete paraplegia (17.5%) Complete paraplegia (23.1%) |
Falls: 22.9% (n=5423) |
| Umaru and Ahidjo 2005 N=36 |
Maiduguri, Nigeria |
1998-2002 Admissions to hospital in Maiduguri with SCI. Exclusion Criteria: Cases with inadequate information |
Males=83% Mean age =34.3±3 (13-55) years Mortality=3 (8%) |
Cervical=14 (39%) Thoracic=10 (28%) Thoracolumbar=10 (28%) Lumbar=2 (6%) Complete=20 (56%) Incomplete=16 (44%) |
Falls: 22.2% (n=8) |
| Dryden et al. 2003 N=450 |
Alberta, Canada |
1997-2000 Data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner |
Male=71.6% Median age of injury=35.0 years |
61.5% (n=277) cervical 17.3% (n=78) thoracic 17.1% (n=77) lumbar/sacral/cauda equina 4.0% (n=18) unspecified |
Falls: 19.1% (n=86) |
| Krassioukov et al. 2003 N=58 |
Toronto, Canada |
1998-2000 Admissions to hospital in Toronto with traumatic SCI. Exclusion Criteria: Patients admitted with ASIA E. |
Group 1 (n=30; Ages 17- 59 years) Males=87% Ages 17-59 years: Mean age=38.7 (17-56) yearsGroup 2 (n=28) Males=61% Ages>60 years: Mean age=73.3 (60-89) years |
ASIA A and B=30% ASIA C and D=70%ASIA A and B=10.7% ASIA C and D=89.3% |
Falls: 30.% (n=9)Falls: 64.3% (n=18) |
| Kuptinatsaikul, 2003 N=83 |
Thailand | 1997-2000 All SCI patients admitted to Spinal Unit, Siriraj Hospital, Nagkok. |
Males=79.5% Average age =32.3 ±11.7 years |
Falls: Tetraplegic n=2 Paraplegic n=6 ASIA D=6 |
Falls: 16.9% (n=14) |
| Pagliacci et al. 2003 N=684 |
Italy | 1997-1999 Rehabilitation admissions to 32 institutions in Italy with traumatic SCI. |
Males = 80% Mean age=38.5 (11-94) years. |
ASIA Scores: A=346 (50%) B=72 (10%) C=149 (22%) D=94 (14%) E=12 (2%) |
Falls: 22.4% (n=153) |
| Pickett et al. 2003 N=2385 |
Ontario, Canada |
1994-1999 SCI in Ontario Trauma Registry |
Males=65% <20 years =89 (9%) 20-39 years= 190 (18%) 40-59 years=245 (24%) ≥60 years=506 (49%) |
No details | Falls: 43.2% (n=1030) |
| Singh et al. 2003 N=483 |
Haryana, India |
2000-2001 Accident and emergency services and department of Orthopaedic Surgery and Rehabilitation of Pt. B.D. Sharma PGIMS, Rohtak. |
Male=74.7% Mean age at injury=35.4 years |
164 tetraplegia 283 paraplegia |
Falls: 44.5% (n=215 |
| Catz et al. 2002 N=250 |
Israel | 1959-1992 Traumatic SCI, admitted to the Loewenstein Rehabilitation Center, the major referral center for rehabilitation medicine in Israel. |
Males=75.6% Mean age = 34.5 years (range 6-83 years). |
High cervical 7.6% low cervical 28.8% thoracic 32.4% lumbar 31.2% |
Falls: 16.8% (n=42) |
| O’Connor, P 2002 N=265 |
Australia | 1998-1999 Australian Spinal Cord Injury Register (ASCIR) for persons 15 years and older. All adult SCI cases are reported to the ASCIR Transient neural deficits were excluded. |
Male=76 % No other demographics given |
C4 n=47 C5 n=45 C6 n=22 L1 n=30 T12 n=17 Incomplete tetraplegia n=101 Incomplete paraplegia n=64 Complete tetraplegia n=51 Complete paraplegia n=48 |
Falls: 31% (n=83) |
| Burke et al. 2001 N=161 |
Kentucky and Indiana counties, USA |
1993-1998 University of Louisville Hospital SCI Trauma Registry and patient medical records |
Male=75% Mean age of injury=45.6 years 59.5% single 29.4% married 86.5% White 13.5% African American |
43% complete (all cases) 58% Frankel A 17% Frankel B 7% Frankel C 15% Frankel D |
Falls: 23% (n=37) |
| Demetriades et al. 2000 SCI=11 |
California, USA |
1993-1997 Los Angeles County and University of Southern California Medical Center |
Male=100% Average age of injury=43.5 years |
Not given. | Falls: 27.3% (n=3) |
| Karacan et al. 2000 N=581 |
Turkey | 1992 Nation-wide survey of SCI admissions to medical institutions. Exclusion Criteria: Patients who died before hospitalization. |
Mean age=35.5±15.1 years. Males=415 (71%) Females=166 (29%) |
Cervical=31.7% Thoracic=26.6% Lumbar=25.1% Tetraplegia=87 (32%) Paraplegia=394 (68%) |
Falls: 36.5% (n=212) |
| National Spinal Cord Injury Statistical Center 2000 N=19648 |
USA | 24 federally funded Model SCI Care Systems and National SCI Database |
Male=81.7% 55% within 16-30 years old, mean age at injury is 31.8 years |
Tetraplegia = 51.7% Paraplegia = 46.7 % Complete Tetraplegia = 18.5% Incomplete tetraplegia = 29.5% Complete Paraplegia = 27.9% Incomplete Paraplegia = 21.3% |
Falls: 21.5% (n=4224) |
| van Asbeck et al. 2000 N=126 (specific data for 113) |
Netherlands | 1994 Patients with SCI in National Registration system. Further analysis occurred only for cases in which medical records were obtained Exclusion Criteria: Spinal contusions with no or temporary neurological symptoms. |
Males=77% <20 years=15 (13%) 21-30 years=28 (25%) 31-60 years=36 (32%) >61=34 (30%) Mortality=18 (16%) | Complete tetraplegia= 26 (23%) Incomplete tetraplegia= 39 (34%) Complete paraplegia= 29 (26%) Incomplete paraplegia= 19 (17%) |
Falls: 48.7% (n=55) |
| Author Year N of study population |
Geographic region |
Inclusion/ exclusion criteria |
Study population |
Injury features | Cause: %(n of cases) |
|---|---|---|---|---|---|
| Hoque et al. 1999 N=179 |
Bangladesh | 1994-1995 Admissions to rehabilitation centre in Savar, Dhaka with SCI. |
Males=88% 10-20 years=19% 20-30 years=42% 30-40 years=20% 40-50 years=15% 50-60 years=4% Mortality=18 (7%) |
Tetraplegia=72 (40%) Paraplegia=107 (60%) |
Falls from height 42.4% (n=76) Falls while carrying load on head 20.7% (n=37) |
| Igun et al. 1999 N=68 |
Plateau State, Nigeria |
1984-1997 Radiologically confirmed diagnosis of spinal cord injury. |
Male=91.2% Mean age = 30 years. |
Cervico-thoracic n=32 Cervico-thoracic n=36 Deaths n=18 |
Falls: 22.1% (n=15) |
| Caldana and Lucca 1998 N=577 |
Veneto, Italy | 1994-1995 New cases of traumatic spinal cord injury and nontraumatic spinal cord disease treated in regional hospitals (small hospitals excluded) |
Male = 83.5% Average age (male) = 39.8 years old Average age (female) = 36 years old |
Cervical=62 (21 were complete) Thoracic=29 (25were complete) Thoracolumbar (T12-L1)=18(11) Caudal=14(3) Unidentified=1 |
Falls: 2.2% (n=13) |
| Farmer et al. 1998 N=1817 |
USA | 1979-1993 Regional Spinal Cord Injury Center of Delaware Valley (RSCICDV) |
Male=78.7% Mean age =37.6 years 72.2% White, 23.5% African American, 2.5% Hispanic 35.9% married 16% unemployed |
62.4% cervical 26.8% thoracic 10.8% lumbosacral 40.9% complete 59.1% incomplete 25.1 % quadriplegia complete 36.7% quadriplegia incomplete 15.8% paraplegia complete 21.5% paraplegia incomplete |
Falls: 26.9% (n=489) |
| Levy et al. 1998 N=136 |
Zimbabwe | 1988-1994 Admissions to National Rehabilitation Centre with traumatic SCI. |
Males=89% Majority were between 20 and 49 years of age |
Cervical=69 (51%) Below Cervical=67 (49%) |
Falls out of trees: 11% (n=15) |
| Martins et al. 1998 N= 398 |
Portugal | 1989-1992 2 hospitals that treat all SCI in the central region of Portugal. Including deaths due to SCI and paediatric cases. Cases without neurological lesion, rehospitalization and vertebral lesions were excluded. |
Males = 77% Average age = 50.53±21.85 years. |
Complete n=220 Incomplete n=176 Deaths = 223 |
Falls: 37.4% (n=149) |
| Aung and Masry 1997 N=219 |
Great Britain | 1985-1988 New traumatic admissions to the Midlands Centre for SCI |
Male=79%; Average age of 35.5 years. Female=21%; Average age of 44.2 years |
Cervical n=116 Thoracic n=73 Lumbar n=30 |
Falls: 42.5% (n=93) |
| Chen et al. 1997 SCI=1,586 |
Taiwan | 1992-1996 113 hospitals (11 medical centers, 50 regional general hospitals, 52 local general hospitals) |
Male=75.0% Average age of injury=46.1 years |
49.9% cervical 13.3% thoracic 34.6% lumbar 6.6% (n=105) died after treatment |
Falls: 44.1%, (n=699) |
| Maharaj 1996 N=75 |
Fiji | 1985-1994 Medical records of spinal cord paralysis patients admitted to the Medical Rehabilitation Unit at Tamavua Hospital |
Male=87% Mean age=38.3 (6-76) years 10 (13%) Fijian=35% Indian=47% |
40 (53%) tetraplegia 35 (47%) paraplegia 46 (61%) complete 29 (39%) incomplete |
Falls: 38.7% (n=29) |
| Karamehmetaglu, 1995 N=152 |
Istanbul, Turkey |
1992 New patients with traumatic SCI, including pediatrics. |
115 males. Mean age = 33 years. 72% of patients were under 40 |
Tetraplegic n=50 Paraplegic n=102 |
Falls: 43% (n=65) |
| Levi et al. 1995 N=353 |
Stockholm, Sweden |
1991-1994 Survey of the regional Stockholm SCI population |
Males=81% Average age of injury=31 (3-77) years |
41.6% (n=147) cervical 36.0% (n=127) thoracic 14.7% (n=52) lumbar 1.4% (n=5) sacral 39.4% (n=139) complete 59.5% (n=210) incomplete |
Falls: 37.1%, (n=131) |
| Shingu et al. 1995 N=9752 |
Japan | 1990-1992 Survey of nationwide institutions assumed to accept SCI patients. Exclusion criteria: Patients only receiving outpatient services in this period |
Males=80.4% Mean age=48.6±19.1 (0.92-96) years |
Frankel levels: A=2518 (25.8%) B=1208 (12.4%) C=1984 (20.3%) D=1761 (18.1%) E=2242 (23.0%) Unknown=39 (0.4%) Cervical=7317 (75.0%) Below cervical=2408 (24.7%) Unknown=27 (0.3%) Complete=61.1% |
Falls: 41.8% (n=4076) From height: 69% (n=6729) On level ground: 31% (n=3023) |
| Hart et al. 1994 N=616 |
South Africa | 1988-1993 All records of SCI from the Natalspruit Spinal Rehabilitation Unit |
Male=80%. Males between 15-40 made up the majority of patients |
Complete n=404 Incomplete n=212 Cervical spine n=155 Upper thoracic n=135 Lower thoracic n=249 Lumbar spine n=74 |
Falls: 2.4% (n=15) |
| Price et al. 1994 N=376 |
Oklahoma, USA |
1988-1990 SCI cases in Oklahoma statewide multilevel surveillance system Exclusion Criteria: Non Oklahoma residents; patients who died at scene; injuries to nerve roots or spinal plexus. |
Males=80% <15 years=12 (3%) 15-19 years=66 (18%) 20-29 years=110 (29%) 30-59 years=145 (39%) ≥60 years =43 (11%) Mortality=30 (8%) |
Complete tetraplegia=55 (15%), Incomplete tetraplegia=157 (42%) Complete paraplegia=59 (16%), Incomplete paraplegia=105 (28%) |
Falls: 19.9% (n=75) |
| Shingu et al. 1994 N=3465 |
Japan | 1990 Survey of nationwide institutions assumed to accept SCI patients; Exclusion criteria: Traumatic cervical syndrome cases and extradural nerve root; Patients only receiving outpatient services in this year or who obtained injury abroad |
Male=81.2% Mean age=44.1 years (sample) Mean age=52.8 years (falls from height) Mean age=61.5 years (falls on level ground) |
Falls from height: Cervical=667 (66%) Below cervical=342 (34%) Unknown=3 Falls on level ground: Cervical=356 (88%) Below cervical=48 (12%) Unknown=3 |
Falls: 41.0% (n=1420) From height: 71% (n=2460) On level ground: 29% (n=1005 |
| Soopramanien 1994 N=412 |
Bucharest, Romania |
1992-1993 SCI patients admitted to Dr Gh. Marinescu Hospital |
Male=77% 0-40 years =41.3% 41-90 years =58.7% 37.6%labourer 8.7% farmer 18.2% retired |
158 cervical 81 thoracic 36 lumbar 47% incomplete Frankel grade A n=134 Frankel grade B n=24 Frankel grade C n=25 Frankel grade D n=73 Frankel grade E n=150 |
Falls: 59% (n=242) |
| Stavrev et al. 1994 N=980 |
Plovdiv Region, Bulgaria |
1983-1992 Treatment for SCI at 2 clinics in Plovdiv region |
Males=72% ≤20 years=82 (8%) 21-40 years=387 (40%) 41-60 years=298 (30%) 61-70 years=137 (14%) >70 years=76 (8%) Mortality=72 (7%) |
Cervical=206 (21%) Thoracic (>T7) =275 (28%) Lumbar=399, (41%) Other=100 (10%) Neurological deficit=409 (42%) No neurological deficit=572 (58%) |
Falls: 55.3% (n=542) |
| Thurman et al. 1994 N=223 |
Utah, USA |
1989-1991 Utah residents with SCI in Statewide reporting system of the Utah Department of Health, Bureau of Epidemiology. |
Male=76% Median age=29 years |
128 (57%) tetraplegia 95 (43%) paraplegia 41 (18%) fatal 21 (9%) died before hospital admission 110 (49%) Frankel A/B/C 46 (21%) Frankel D 25 (11%) full neurological function |
Falls: 21.1% (n=47) |
| Woodruff and Baron 1994 N=150 |
West Virginia, USA |
1985-1988 Data collected during the West Virginia Spinal Cord Injury Registry, includes only injured patients surviving until hospitalization |
Male= 82% Majority of individuals were between 15-24. |
48% tetraplegia 52% paraplegia |
Falls: 21% (n=31) |
| Acton et al. 1993 N=644 |
Arkansas, USA |
1980-1989 Arkansas residents in Arkansas State Spinal Cord Commission registry. Exclusion Criteria: Lesions caused by degenerative disease; people who died at scene. |
Males=80% Mean age males=32.4 years Mean age females=35.4 years |
Tetraplegia=37 Paraplegia=45 Unknown=4 |
Falls: 13.4% (n=86) |
| Dixon et al. 1993 N=164 |
New Zealand | 1988 SCI cases in Health Services Statistics files. |
Males=73.2% Males aged 15- 29 years=46% |
C1-C4=49 (30%) C5-C7=30 (18%) T1-T6=19 (12%) T7-T12-19 (12%) |
Falls: 24% (n=39) |
| Lan et al. 1993 N=99 |
Hualien county, Taiwan |
1986-1990 Treatment of traumatic SCI in 4 hospitals in Hualien county. Exclusion Criteria: People who died before hospitalization; nontraumatic SCI; patients with transient paralysis; non residents of Hualien |
Males=80% Mean age (males)=44 years Mean age (females)=46 years Mortality=10 (10%) |
Complete tetraplegia =5 Incomplete tetraplegia = 5 Complete paraplegia =6 Incomplete paraplegia = 7 |
Falls: 23.3% (n=23) |
| da Paz et al. 1992 N=1255 (SCI=108) |
Brazil | 1988 36 public hospitals from 7 Brazilian capitals (represents 6.2% of all hospitals and 9.2% of the total hospital bed capacity. |
Males=80.6% Mean age= 30.3 (range 6-56) years 5.6% high education |
94 (87.0%) complete 61 (64.9%) paraplegia 33 (35.1%) quadriplegia |
Falls: 14.8% (n=16) |
| DeVivo et al. 1992 N=6563 |
USA | Admissions to Spinal Cord Injury Care Systems within 1 year of injury from: 1978-19801981-19831984-1986 |
Males=82.4% Mean age =28.4 yearsMales=82.7% Mean age =30.5 yearsMales=84.5% Mean age =31.2 years |
Frankel grade at discharge: Complete=51.8% Sensory=13.7% Motor nonfunctional=7.2% Motor functional=25.9% Recovered=1.4%Frankel grade at discharge: Complete=57.2% Sensory=11.7% Motor nonfunctional=7.8% Motor functional=22.5% Recovered=0.8%Frankel grade at discharge: Complete=48.6% Sensory=16.2% Motor nonfunctional=11.0% Motor functional=23.5% Recovered=0.6% |
Falls: 20% (n=1313)Falls: 18.8% (n=1234)Falls: 22.2% (n=1457) |
| Dincer et al. 1992 N=1,694 |
Turkey | 1974-1985 SCI patients admitted to Ankara Rehabilitation Centre |
Average age of injury=26.8 (1-70) years 75.68% (n=1282) male 19.83% (n=336) agricultural workers 19.95% (n=338) housewives 19.48% (n=330) private industry workers |
85.12% (n=1442) complete paraplegia 6.85% (n=116) incomplete paraplegia 4.84% (n=82) complete tetraplegia 3.19% (n=54) incomplete tetraplegia |
Falls: 29.51% (n=500) |
| GarciaReneses et al, 1991 N=1010 |
Spain | 1984-1985 Every traumatic and non traumatic SCI patient in specialized Spanish hospitals |
Male=72.4%. Mean age = 41.8 ± 1.2 years. |
Sensory-motor incomplete SCI = 49% Complete SCI= 38% |
Falls: 27% (n=273) |
| Goebert et al. 1991 N=59 |
Hawaii, USA |
1987-1989 Traumatic injury Patient at the Rehabilitation Hospital of the Pacific |
Male=84.7% Mean age=20.2 years 0-5years=5.2% 16-30 years=44.8% 31-45 years=25.9% 46-60 years= 12.1% 61-90 years=12.1% |
High Quad (C1-4)=16.2% Low Quad (C5-8)=45.9% High Thoracic (T1- 6)=18.9% Low Thoracic (T7- 12)=10.8% Lumbar (L1-5)=8.1% Frankel Grades: Complete (A)=50.8% Motor functional (D)=35.6% |
Falls: 27.6% (n=16) |
| BieringSorensen et al. 1990 N=268 |
Kingdom of Denmark (Denmark, Greenland, Faroe Islands) |
January 1975- December 1984 Admission to national specialized rehabilitation hospitals |
Male=76.9% 40% within 15-24 years old |
Cervical = 136 Thoracic = 76 Lumbar = 56 Complete tetraplegia = 22% Incomplete tetraplegia = 29% Complete paraplegia = 26% Incomplete paraplegia = 23% |
Falls to level below: 23% (n=61), Falls to same level: 3% (n=9) |
| Pedersen et al. 1989 N=27 |
Greenland | 1965-1986 Admissions to rehabilitation hospital in Hornback with traumatic SCI; Patients injured in Greenland. |
Males=74% Mean age=33.5 (14-50) years. |
Complete tetraplegia=2 Incomplete tetraplegia=4 Complete paraplegia=1 Incomplete paraplegia=2 |
Falls: 33.3% (n=9) |
| Ring et al. 1986 N=202 |
New South Wales, Australia |
1977-1978 Admissions to New South Wales hospitals with spinal injury; death certificates that involved spinal injury. 99% of cases had neurological involvement |
Males=81% 15-24 years=84 (42%) 25-44 years=58 (29%) 45-64 years=30 (15%) ≥65 years=15 (7%) Mortality=69 (39%) |
Glasgow Outcome Scale: Severe disability=98(49%) Moderate disability=19(9%) Good recovery=13(6%) Not recorded=3(1%) |
Falls: 9.4% (n=19) |
| Griffin & Opitz 1985 N=154 |
Olmsted County, Minnesota, USA |
1935-1981 Medical recordslinkage system of the Rochester Project at the Mayo Clinic, periodic multi-centre surveys |
Male=72% 153 White, 1 Black |
56.5% (n=87) cervical 31.8% (n=49) thoracic 9.1% (n=14) lumbar 2.6% (n=4) sacral |
Falls: 13.0% (n=20) |
| Gee and Sinha 1982 N=36 |
Papua New Guinea |
1978-1981 Traumatic injury Patients that stayed in Port Moresby, Lae and Manding hospitals |
Male = 88% Mean age = 26years (range 16-41 years) |
Cervical = 22% Upper thoracic = 11% Thoraco-lumbar = 28% Lumbar = 39% |
Falls from trees: 31% (n=11) Falls from roof : 9% (n=3) |
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