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Epidemiology of Traumatic SCI

Natural Disasters

Although natural disasters of significant magnitude are rare, their occurrences can have devastating effects. Natural disasters have the potential to not only lead to mass casualties but also to a sudden high frequency of severely injured persons. Because SCIs are only one type of severe injury that requires specialized and specific care, triage schemes are applied in order to allocate scarce resources to those who are most likely to benefit (Bensen et al. 1996Jenkins et al. 2008). In such instances, patients with complex trauma might not be given immediate priority because of their smaller probability of survival (Gautschi et al. 2008) or surgical care may not be regarded as an immediate priority because resources are scarce (Sheng 1987). Thus individuals with SCI, in particular those with high lesions who may require surgical spinal stabilization and intensive acute care, may not receive the needed services, especially in regions with a lack of resources like transport facilities.

In low resource countries the health care infrastructure for SCI care and provision of pre-hospital, acute care, and rehabilitation are often inadequate. When faced with the consequences of a natural disaster, the health system becomes exposed with the understaffed and underequipped local medical emergency teams, and the lack of efficient transportation to provide services to remote rural regions. Even in regions with sufficient infrastructures, health services may be overwhelmed if many patients with major trauma need to be admitted at the same time. Regardless of region, most lay persons and first responders providing rescue and medical aid to survivors are not trained to provide adequate care for persons with SCI and do not know how to transport these individuals safely. Secondary lesions may result from well-intended but harmful manipulation.

We identified 12 studies with a focus on SCI resulting from natural disasters (Table 13). These papers cover the earthquakes in Tangshan, China in 1976, Yerevan, Armenia in 1988, Hanshin, Japan in 1995, Bam, Iran in 2003, Kashmir, Pakistan in 2005, Sichuan, China in 2008, and Haiti in 2010. Of note, we did not find any publications reporting on SCI resulting from other types of natural disasters.

The frequency of SCI among all injuries ranged from 0.02% in Japan and Iran (Maruo et al. 1996Tahmasebi et al. 2005) to a high of 1.2% (n = 5000 SCIs) in China (Chang et al. 2000).

The majority of injuries reported were to the lumbar region of the spine, (Chen et al. 2009Dong et al. 2009Tauqir et al. 2006Chang et al. 2000Tanaka et al. 1999Maruo et al. 1996Karamouzian et al. 2010) however, not all injuries resulted in damage to the spinal cord. The most common mechanism of SCI was being struck by a falling object while sitting or standing (Rathore et al. 2007Maruo et al. 1996).

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study

population

Injury features Cause: %(n of

cases)

Burns et al. 2010
N=19 (SCI)
Estimated
Deaths= 250,000-
300,000
Estimated
Injuries= 300,000
Estimated SCI
survivors= 150
Haiti Patients with SCI at
the Haiti Hospital
Appeal as a result of
the earthquake
(magnitude 7.0) on
January 12, 2010 in
Haiti
Not Provided Cervical= 1 (5.2%) (C6
motor complete)
Asia A or B =13 (68.4%)
– Majority low thoracic or
lumbar spine injuries
– High thoracic injuries
uncommon
Earthquake
12.7%
(n=19)
Karamouzian et
al.
2010
N= 130 (SCI)
Estimated
Injured= 30,000
Bam,
Iran
2005-2006
Registered
participants at the
Kerman Welfare
Organization
Surveyed
sample
(remaining
n=103)
Male= 40.8%
Female= 59.2%
Mean age=
31.5±10.2 years
Cervical= 2 (1.9%)
Thoracic= 8 (7.8%)
Thoracolumbar= 93
(90.3%)
Earthquake:
0.43%
(n=130)
Chen et al.
2009
N=78
Estimated
injured= >300,000
Sichuan,
China
Treatment for spinal
injuries in Chengdu
hospital following
May 12, 2008
earthquake
(magnitude 8.0).
Males=51%
Mean age=42(7-
84) years
Women=38
(49%)
No Mortality
Cervical=13 (11%)
Thoracic=48 (40%)
Lumbar=58 (49%)
Single level injuries=55
(71%)
Multiple level injuries=23
(29%)
Neurological
disability=53.8%
Earthquake:
0.03%
(n=78)
Dong et al.
2009
N=198(SCI)
Estimated injuries
374,643
Sichuan,
China
Patients admitted to
hospital in Sichuan
region with spinal
injuries from
earthquake
(magnitude 8.0) on
May 12 2008.
Exclusion Criteria:
Patients injured by
earthquake-related
MVCs.
Not provided Lumbar injuries = 55.3%
Thoracic injuries = 31.1%
Neurologic deficit in 65
patients:
Frankel Levels:
A=14 (7%)
B=8 (4%)
C=24 (12%)
D=19 (10%)
Earthquake:
0.05%
(n=198)
Raissi et al.
2007
N=54
Estimated
injured=
23,000
Bam,
Iran
SCI patients listed
with Social Welfare
Organization in Bam
area and were
injured in the
December 6, 2003
earthquake
(magnitude 6.8) in
Bam, Iran
Patients
surveyed n=54
Male=46%
Mean
age=31.9±9.6
years
General injury level*:
Between T10 and T12=37
L2 and below=14
Incomplete=3
*(complete neurological
level exam not possible)
Pain syndromes=52 (96%)
Earthquake:
0.23% (n=54)
Rathore et al.
2007
N=187
Estimated
injured= 126,000
Northern
Pakistan
Patients with SCI
from the earthquake
(magnitude7.6) on
October 8, 2005 in
Rawalpindi.
Surveyed
sample (n=187)
Males=43%
Mean
age=28.3±12.4
years
Complete paraplegia=
43% (n=81)
Incomplete paraplegia=
46% (n=86)
Incomplete tetraplegia=
5% (n=9)
No neurological deficit=
6% (n=11)
Earthquake:
0.15%
(n=187)
Tauqir et al.
2006
N=194
Estimated
injured= 100,000
Northern
Pakistan
Admission to 4
hospitals in
Rawalpindi and
Islamabad with SCI
due to earthquake
on October 8, 2005
(magnitude7.6).
Surveyed
Sample (n=122)
Males=26%
16-39 years
=77% (n=151)
Cervical=5 (3%)
Thoracic=48 (25%)
Lumbar=120 (62%)
Thoracolumbar=18 (9%)
Cervicothoracic=1
Lumbrosacral=1
Cord contusion=1
Earthquake:
0.19% (n=194)
Tahmasebi et al.
2005
N=210
N=6 (SCI)
Estimated
injured= 30,000
Bam,
Iran
Patients admitted to
hospitals in Tehran
with musculoskeletal
injuries following
earthquake on
December 26, 2003
(magnitude 6.8).
Surveyed
sample (n=210)
Male=42.4%
Mean age=30.2
(7-70) years.
Not provided Earthquake:
0.02%
(n=6)
Chang et al.
2000
N=5000
Estimated
injuries= 420,000
Tangshan
,
China
Individuals who
sustained SCIs in
the Tangshan
earthquake
(magnitude 7.8) on
July 28, 1976.
Sampled
surveyed
(n=105)
Males= 31.4%
Average age=46
(38-62) years.
T12/L1= 86.5% (n=64) Earthquake:
1.2%
(n=5000)
Tanaka et al.
1999
N= 29 (SCI)
Estimated
Injured= 41,000
Hanshin
region,
Japan
Survey of 53% of all
hospital beds in
Hanshin area in first
15 days following
the January 17,
1995 earthquake
(magnitude 7.2).
Exclusion criteria:
Patients who were
dead upon arrival to
hospital.
Patients
surveyed
n=6107
Males=44%
Total
mortality=527
(9%)
Mortality among
SCI=1 (3%)al
Spinal cord injuries=29
Spinal fractures (n=414):
Cervical=18 (4%)
Thoracic=145 (35%)
Lumbar=251 (61%)
Earthquake:
0.07%
(n=29)
Maruo and
Matumoto
1996
N=6 (SCI)
Estimated
injured=
34,900
Hanshin
region,
Japan
Interviews of
patients suffering
from spinal or truck
injuries following the
January 17, 1995
Hanshin earthquake
(magnitude 7.2).
Patients
surveyed n=230
Males=29.6%
Average
age=62.9%
Frankel levels (n=6)
A=3
D=3
Most common levels of
vertebral fracture (n=140)
T12=49 (29%)
L1=49 (29%)
L2=25 (15%)
L3=11 (6.5%)
Earthquake:
0.02%
(n=6)
Burke et al.
1993
N=42 (SCI)
Estimated
injured=
150,000
Yerevan,
Armenia
Patients admitted to
newly established
SCI unit following
Armenian
earthquake on
December 7, 1988.
No information
given.
All patients with
paraplegia.
Minor paralysis=35.7%
(n=15)
Severe paralysis=64.3%
(n=27)
Confined to a
wheelchair=16.3% (n=7)
Mortality=5% (n=2)
Earth-quake:
0.03%
(n=42)
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