See All Evidence Sections
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. 1995Shingu 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 2010DeVivo 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 2010McCammon and Ethans 2011Lenehan 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. 2010Van Den Berg et al. 2011Knutsdottir 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. 2010Ning et al. 2011Li et al. 2011Wu et al. 2012Wang et al. 2013), and 5 studies reported falls as the second leading cause (Chabok et al. 2009Wu et al. 2011Chhabra and Arora 2012; Ibrahim et al. 2013Hua 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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