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Epidemiology of Traumatic SCI

Motor Vehicle Crashes

There were 84 studies reporting on SCI as a result of motor vehicle crashes (MVC) (Table 7). These studies presented statistics from 30 different countries; all continental regions were covered by at least one study. A variety of data sources were used including national and regional registries and national, regional or local hospital admission/discharge records or surveys. The studies used a variety of methods to collect and aggregate data. North America had the most studies (N=26), primarily from the United States (N=17 studies), followed by Europe (N=23 studies).

The proportion of SCI related to MVCs ranged from 6.9% in Nepal (Shresta et al. 2007) to 89% in Nigeria (Olasode et al. 2006). The most frequent proportion fell within the 40-49.9% range (N=22 studies) followed by the 30-39.9% range (N=19 studies). Differences in inclusion criteria may be one of the primary reasons for the wide variation of reported estimates as some studies included all causes of SCI while others excluded non-traumatic causes or other subgroups such as patients with neurodegenerative diseases, or individuals with or without neurological deficits.

In the United States and Canada, MVCs are the most common cause of SCI. Most recent estimates indicate MVCs account for 41% to 45% of SCIs in the United States (National Spinal Cord Injury Statistical Center February 2010DeVivo and Chen 2011). In British Columbia, Alberta, and Manitoba Canada, MVCs are the primary cause of SCI (Lenehan et al 2012Dryden et al. 2003McCammon and Ethans 2011). Data from Manitoba indicated that the relative proportion of SCIs resulting from MVCs declined over time as indicated by decreasing frequencies among three different cohorts (47.4,%, 39.3%, 34.9%) sampled at three different time points between 1981 and 2007 (McCammon and Ethans 2011). Over this time, an increase in the frequency of females incurring a SCI due to MVCs was also observed (McCammon and Ethans 2011). Contrary to this, Pirouzmand (2010) reports an increase in relative frequencies of SCI due to MVCs from 1986 to 2006, in Toronto, Ontario, Canada, and Couris et al. (2010) report consistent frequencies from 2003 to 2006 in all of Ontario, Canada, with more women (28.5%) than men (23.0%) sustaining SCI.

Most recent estimates from Europe indicate MVCs to be the leading cause of SCIs in regions of Spain, Iceland and Turkey, and the second most common in regions of Norway. In Aragon, Spain, MVCs were the most common cause of SCI (57.0%) between 1972 and 2008, with higher incidence in males than females for all ages (Van Den Berg et al. 2011). Similarly, Cosar et al. (2010) report MVCs have accounted for 55.1% of SCIs among 127 individuals taking part in an in-patient rehabilitation program in Turkey between 1996 and 2008. In two counties in Norway, MVCs were found to be the second leading cause (34.2%) of SCI between 1952 and 2001. During this observation period MVCs resulting in a SCI increased overall and specifically among younger (<30 years) males (Hagen et al. 2012).

In Asia, MVCs are the primary cause of SCI in Taiwan (58.8%) (Wu et al. 2011), Iran (52.0%) (Chabok et al. 2009), Saudi Arabia (85%) (Alshahri et al. 2012), India (45%) (Chhabra and Arora 2012) and in one study from China (Hua et al. 2013). Other studies from the region found that MVCs were the second leading cause of SCI, including in Beijing (22.3%) and other areas of China (Tianjin (34.1%; 36.4%) (Ning et al. 2011Li et al. 2011Wu et al. 2012) as well as Pakistan (32.0%) (Qureshi et al. 2010). Similar to other studies, MVCs leading to SCI were most common among young, males, with MVCs occurring due to fatigue with highway driving without the use of seatbelts (Ning et al. 2011).

Two papers with a specific focus on SCIs resulting from MVCs were found in the most recent update. One paper reporting on MVCs in the United States used both the Crash Injury Research Engineering Network (CIREN), and the National Automotive Sampling System’s Crashworthiness Data System (NASS-CDS) databases (Stein et al. 2011). The CIREN database includes only newer fleet of vehicles and thus newer safety features, in addition to the reporting of significant injuries, whereas the NASS-CDS database represents a national probability sample of vehicles that are involved in any police-reported MVCs. The authors found that among the more serious MVCs as those included in the CIREN database, 11.5% of case occupants (n=3,524) had cervical spine injuries, whereas 0.35% of all occupants (N=48,660,000) in the NASS-CDS database sustained a cervical spine injury. Rollover and other severe crashes led to much higher risk of cervical spine injury. Older individuals (>65 years) were at an increase risk of cervical spine injury. Seat belt use was effective at preventing cervical spine injuries whereas airbag deployment may increase the risk of sustaining a cervical spine injury when in a serious MVC.

Lieutaud et al. (2010) reported on data from an epidemiological database of every MVC requiring medical attention in health facilities in the Rhone area of France since 1995. From 1997 to 2006, 144 (0.15%) individuals suffered a SCI out of the 97,341 patients included in the database. Cervical SCIs were the most frequent type of injury. More motorcyclists sustained a SCI compared to other types of major spinal trauma. Being younger, male, a motorcyclist, and not wearing a seatbelt were identified as risk factors for SCI.

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
MVC Specific:
Incomplete: 47.7%
Cervical (55.7%)
Cervical-Thor (4.5%)
Thoracic (32.8%)
Thor-Lumbar (4.5%)
Lumbo-sacral (2.4%)
51.2%
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 years
Tetraplegia: 37% (108)
Paraplegia: 63% (180)
Traumatic:
MVC: 66%
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%)
21.2%
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%
MVC:
85% (n=262)
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%
Road traffic
accident: 45%
Knutsdottir
2012
N=207
Iceland 1975-2009 Patients admitted to Landspitali University Hospital Males: 72%
Mean Age: 38 years
Males: 72%
Mean Age: 38 years
Road traffic
Accidents:
42.5%
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%
Motor vehicle
accident: 51.4%
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 MVC (on-road):
31.2%
MVC (off-road):
9.3%
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%
MVC = 29.4%
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%
MVC = 36.4%
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
MVC
45.4%
(n=20,631)
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
(n=13, 4.9%)
Thoracic
(n=74, 28%)
Thoracolumbar, lumbar
and lumbosacral (n=176,
66%)
MVC:
22.3%
n=59
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 GuillanBarre 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%
Motor vehicle
accident:
81-85: 44.5%
98-02:31.1
03-07: 28.8
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%)
MVC:
(34.1%)
n=296
Stein et al.
2011
N=3524
USA Case occupants older than 14 years old and in a vehicle accident between 1996 – Nov 2009 with cervical spine injuries. 1691 male
(49.3%)
Automobile: 2,457, 71.5%
Light truck: 305, 8.9%
Utility vehicle: 460, 13.4%
Van-based truck: 213,
6.2%
MVC:
Frontal crash:
2,096, 61.4%
Lateral:
1,094, 31%
Rollover:
142. 4.0%
Other:
80, 2.3%
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
Traffic accidents
(57%)
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
MVC:
(58.8%)
n=14,955
calculated using
N traumatic SCI=
25,439)
Cosar et al.
2010
N TSCI=127
Turkey Patients with traumatic SCI who participated in an inpatient 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
MVC;
(55.1%)
n=70
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
MVC:
(24.5%)
n=229
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 Sognog 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%)
MVC: 34.2%
n=104
Car accident
19.9%
Motorcycle
accident 6.8%
Bicycle accident
4.2%
Pedestrian3.0%
Lieutaud et al.
2010
N=1523
(MST)
N=144
(SCI)
France 1997-2006 Major spinal trauma (MST, AIS score 2 or more) and SCI (AIS score 4 or more) Males= 63%
Female= 37%
MST:
40% cervical
33% thoracic
36% lumbar
SCI:
58% cervical
37% thoracic
6% lumbar
MST:
Car occupant
(n=804)
2-Wheel
motorized riders
(n=329)
Pedestrians
(n=165)
Cyclists (n=124)
Others (n=101)
SCI:
Car occupant
(n=73)2-Wheel
motorized riders
(n=47)
Pedestrians
(n=13)
Cyclists (n= 7)
Others (n=4)
NSCISC
2010
N=26,852
USA 1973-2009 26 federally funded Model SCI Care Systems and National SCI Database Male= 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%
MVC:
41.3%
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%
MVC:
57%
Qureshi et al.
2010
N=521
Rawalpindi,
Pakistan
All patients who suffered a spinal injury 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%)
Complete SCI-(43%)
Incomplete SCI- (33%)
Road traffic
accident:
(32%)
n=166
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
MVC:
(52%)
n=127
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
MVC:
77.4% (n=362)
Ahoniemi et
al. 2008
N=1647
Finland 1976-2005 Register survey; Medical records from registers of Käpylä Rehabilitation Centre Male= 83%
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
MVC:
39.5% (n=650)
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
MVC:
63% (n=188)
National
Spinal Cord
Injury
Statistical
Center
2008
N=25,415
USA 1973-2008 Residents of the US who have sustained traumatic SCI. Data from Model SCI Care Systems captures approx 13% of all new SCI cases in the U.S Male=77.8%
(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%
MVC:
42% (n=10,674)
Fassett et al.
2007
N=412
Philadelphia,
Pennsylvania,
USA
1978-2005 Geriatric patients 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%
MVC:
13% (n=54)
Pedes-trian:
2% (n=8
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%)
MVC:
21.5%
(n=32)
Olasode et al.
2006
N=71
Ile-Ife,
Nigeria,
Africa
All traumatic SCI within an 18 month period were included. Only patients with significant craniocerebral injuries were excluded. Males=66.7%
Age range=12-80
years
tetraplegic n=39
paraplegic n=13
recovered with no residual
disability n=14
died n=5
MVC:
89%
(n=63)
Pickett et al.
2006
N=151
London,
Ontario,
Canada
1997-2006 Admissions to hospital in London, Ontario with SCI Men=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%
MVC:
35.1% (n=53)
Other type of
vehicle
11.9% (n=18)
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%
MVC:
43.2% (n=99),
Pedestrians hit
by car=3.9%
(n=9),
Motorcycle=1.7%
(n=4)
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
MVC:
35%
(n=53)
Gur et al.
2005
N=539
Southeastern
Anatolia,
Turkey
1990-1999 4 hospitals that were major referral centers for trauma Male= 77.2%
Average age of
injury=30.62
(1-70) years
Incomplete paraplegia
29.3% (n=158)
Complete paraplegia
45.1% (n=243)
Incomplete tetraplegia
13.7% (n=74)
Complete tetraplegia
13.9% (n=75)
Cervical: 25.4% (n=137)
Thoracic: 36.7% (n=198)
Lumbar: 34.0% (n=183)
MVC:
37.1% (n=200)
Lakhey et al.
2005
N=233
Dharan,
Nepal
May 1997- April 2001 Orthopaedic ward of BP Koirala Institute of Health Sciences 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%
MVC:
6.9%
(n = 16)
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%)
MVC:
61.1%
(n=22)
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 71.6% male
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
MVC:
56.4% (n=254)
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.
Males=87%
Ages 17-59
years:
Mean age=38.7
(17-56) years
ASIA A and B=30%
ASIA C and D=70%
MVC:
31%
(n=18)
Kuptniratsaikul
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.
Tetraplegic n=19
Paraplegic n=18
ASIA D=25
MVC:
75.7%
(n=63)
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%)
MVC:
53.8%
(n=684)
Pickett et al.
2003
N=2385
Ontario,
Canada
1994-1999 SCI in Ontario Trauma Registry Males=69%
<20 years =17%
20-39
years= 44%
40-59 years=23%
≥60 years=16
Not given. MVC:
42.8% (n=1021)
Automobile
=75%
Motorcycle
=7%
Bicycle=3%
Pedestrian
=6%
Other=10%
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%
male
Mean age at
injury=35.4 years
164 tetraplegia
283 paraplegia
MVC:
34.8% (n=168)
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%
MVC:
32.8% (n=82)
O’Connor
2002
N=265
O’Connor
2002
N=265
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
MVC:
43%
(n=114)
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% male
Mean age of
injury=34.0 years
59.5% single
29.4% married
85.5% White
14.5% African
American
56.5% cervical
28% complete
(all cases)
58% Frankel A
17% Frankel B
7% Frankel C
15% Frankel D
MVC:
54.7% (n=88)
Karacan et al.
2000
N=581
Turkey 1992 Nation-wide survey of SCI admissions to medical institutions.
Exclusion Criteria: Patients who died before hospitalization.
Males=71%
Mean
age=35.5±15.1
years.
Females=166
(29%)
Cervical=31.7%
Thoracic=26.6%
Lumbar=25.1%
Tetraplegia=87 (32%)
Paraplegia=394 (68%)
MVC:
48.8% (n=283)
National
Spinal Cord
Injury
Statistical
Center
(NSCISC)
2000
N=19648
USA 1973 -1990’s 24 federally funded Model SCI Care Systems and National SCI Database Male= 81.7%
Mean age at
injury=31.8 years;
55% within 16-30
years old
Tetraplegia = 51.7%
Paraplegia = 46.7 %
Complete Tetraplegia =
18.5%
Incomplete tetraplegia =
29.5%
Complete Paraplegia =
27.9%
Incomplete Paraplegia =
21.3%
MVC:
37.4%
(n= 7348)
Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: % (n of
cases)
Ravaud et al.
2000
N=1668
France 1995-1996 Self-administered questionnaire survey at 35 specialized Rehabilitation Centres Males (73%)
Mean age of
injury=30.5 years
7.4% C1-C2
16.4% C3
26.3% C4
28.5% C5
18.6% C6
2.5% C7-C8
54% complete
MVC:
57.9% (n=959)
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%)
MVC:
31.0% (n=35)
Igun et al.
1999
N=68
Plateau
State,
Nigeria
1984-1997 Radiologically confirmed diagnosis of spinal cord injury. Males=91.2%
Mean age = 30
years.
Cervico-thoracic n=32
Cervico-thoracic n=36
Deaths n=18
MVC:
51.5% (n=35)
Caldana and
Lucca
1998
N=127
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 of
39.8 years
Female = 16.5%;
average age of36
years
Cervical=62 (21 were
complete)
Thoracic=29(25)
Thoracolumbar (T12-
L1)=18(11)
Caudal=14(3)
Unidentified=1
MVC:
53%
(n=306)
Other road
accidents=19%
(n=110)
(Motorbike=7,
Moped=7,
Bicycle=3,
Pedestrian=2)
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
MVC:
29.9% (n=543)
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%)
MVC:
50%
(n=68)
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. Male=77%
Average age =
50.53±21.85
years
Complete n=220
Incomplete n=176
Deaths = 223
MVC:
57.3% (n=228)
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
MVC:
50%
(n=110)
Exner and
Meinecke
1997
N= 22,212
Germany 1976-1996 All traumatic and non-traumatic SCI 72% male 62% paraplegic
38% tetraplegic
MVC:
35% (n=7774)
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
Fijian=60%
Indian=35%
Employed
=47%
Unemployed
=41%
40 (53%) tetraplegia
35 (47%) paraplegia
46 (61%) complete
29 (39%) incomplete
MVC:
25.3%
(n=19)
Karamehmetaglu et al.
1995
N=152
Istanbul,
Turkey
1992 New patients with traumatic SCI, including pediatrics. Males=75.6%
Mean age = 33
years. 72% of
patients were
under 40.
Tetraplegic n=50
Paraplegic n=102
MVC:
41%
(n=62)
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
Cervical 41.6% (n=147)
Thoracic 36.0% (n=127)
Lumbar 14.7% (n=52)
Sacral 1.4% (n=5)
Complete 39.4% (n=139)
Incomplete 59.5% (n=210
MVC:
45.6% (n=161)
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%
MVC:
43.7% (n=4261)
Silberstein
and
Rabinovich
1995
N=196
Novosibirsk,
Russia
1989-1993 All in patients with SCI admitted to the Department of SCI. Nerve root or plexus injury was excluded. Males=93.4%
Mean age =34.7
years.
Cervical spine
C1-2 n=15
C3-7 n=81
Thoracic T1-12 n=54
Lumbar L1-5 n=46
MVC:
25.1%
(n=49)
Thurman et al.
1995
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%) returned to full
neurological function
MVC=
49.3%
(n=110)
Hart et al.
1994
N=616
South Africa 1988-1993 All records of SCI from the Natalspruit Spinal Rehabilitation Unit Males=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
MVC:
25%
(n=154)
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.
Male= 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%)
MVC:
47.9% (n=180)
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
Cervical=1218 (79%)
Below cervical=328 (21%)
Unknown=1
MVC:
44.6% (n=1545)
Soopramanie
1994
N=412
(SCI=270)
Bucharest,
Romania
1992-1993 SCI patients admitted to Dr. Gh. Marinescu Hospital Males=77%
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
MVC:
13%
(n=54)
Stavrev et al.
1994
N=980
Plovdiv and
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%)
MVC:
37.4% (n=367)
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.
57% tetraplegia
43% paraplegia
MVC:
57%
(n=86)
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=124
Paraplegia=181
MVC:
80% (n=515)
Motorcycle= 11%
(n=71)
Off road
vehicles= 4%
(n=26)
Bicycles= 3%
(n=19)
Pedestrian = 2%
(n=13)
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%)
MVC:
54%
(n=89)
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
MVC:
61.6%
(n= 61)
Tator et al.
1993
N=201
Toronto,
Canada
1974-1981 First 220 admissions to Acute Spinal Cord Injury Unit in Toronto.
Exclusion Criteria: Admissions >30 days after injury; spinal injuries without cord involvement; nerve root involvement only; penetrating injuries; injuries below L2; Patients who died on scene or upon arrival.
Males=79.6%
Mean age=34.5
years
Median age=27.0
years
Cervical=63.2%,
Thoracic=16.9%,
Thoracolumbar=19.9%
Complete=46.2%,
Incomplete=53.8%
MVC:
40.8% (n=82)
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. Male=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
MVC:
41.7% (n=45)
DeVivo et al.
1992
N=6563
USA Admissions to Spinal Cord Injury Care Systems within 1 year of injury from: 1973-1977 N=1955
Males=81.9%
Mean age=28.0
years
Frankel grade at
discharge:
Complete=56.4%
Sensory=9.7%
Motor nonfunctional=9.0%
Motor functional=24.1%
Recovered=0.8%
MVC:
42.5%
1978-1980 N=1784
Males=82.4%
Mean age=28.4
years
Frankel grade at
discharge:
Complete=51.8%
Sensory=13.7%
Motor nonfunctional=7.2%
Motor functional=25.9%
Recovered=1.4%
MVC:
48.0%
1981-1983 N=1391
Males=82.7%
Mean age=30.5
years
Frankel grade at
discharge:
Complete=57.2%
Sensory=11.7%
Motor nonfunctional=7.8%
Motor functional=22.5%
Recovered=0.8%
MVC:
48.8%
1984-1986 N=1433
Males=84.5%
Mean age=31.2
years
Frankel grade at
discharge:
Complete=48.6%
Sensory=16.2%
Motor
nonfunctional=11.0%
Motor functional=23.5%
Recovered=0.6%
MVC:
44.9%
Dincer et al.
1992
N=1,694
Turkey 1974-1985 SCI patients admitted to Ankara Rehabilitation Centre Males = 75.7%
Average age of
injury=26.8 (1-70)
years
Agricultural
workers=
19.8% (n=336)
Housewives=
19.9% (n=338)
Private industry
workers =
19.5% (n=330)
Complete paraplegia
85.1% (n=1442)
Incomplete paraplegia
6.9% (n=116)
Complete tetraplegia
4.8% (n=82)
Incomplete tetraplegia
3.2% (n=54)
MVC:
35.4% (n=600)
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%
MVC:
52.2% (n=527)
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
0-15years=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%
MVC:
37.9% (n=22)
automobile
=81.1% of
motorcycle
=13.6%, bicycle
=4.5%
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
268 traumatic lesions
Cervical = 136
Thoracic = 76
Lumbar = 56
Complete tetraplegia =
22%
Incomplete tetraplegia =
29%
Complete paraplegia =
26%
Incomplete paraplegia =
23%
MVC:
47%
(n=125)
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%
≤1 years=2 (1%)
2-14 years=13
(6%)
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%)
MVC:
65.3% (n=132)
Chen et al.
1985
N=560
Taipei,
Taiwan
1978-1981 All record from general hospitals in Taipei. Included all spinal cord lesions with or without vertebral injury. Males=86%
Mean age = 35.9
(range 20-49)
years.
Incomplete Paraplegia
n=118
Complete paraplegia
n=180
Incomplete Tetraplegia
n=117
Complete Tetraplegia
n=145
Death n=31
MVC:
44.5% (n=249)
Griffin and
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
MVC:
69.8% (n=106)
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%
MVC:
34 %
(n=12)
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