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 2010; DeVivo and Chen 2011). In British Columbia, Alberta, and Manitoba Canada, MVCs are the primary cause of SCI (Lenehan et al 2012; Dryden et al. 2003; McCammon 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. 2011; Li et al. 2011; Wu 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 |
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% |
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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% |
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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% |
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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) |