Epidemiology of Traumatic SCI
Other Causes
There were 48 papers reporting SCI due to “other causes” (Table 14). In some studies, this may have included the specific causes discussed above, miscellaneous causes not mentioned earlier or unique causes of SCI. The majority of studies were from Europe (N=16 studies) with some representation from North America (N=13 studies), Asia (N=12 studies), Africa (N=3 studies) and Oceania (N=4 studies). Eighteen of these studies reported SCI due to being struck by an object.
Proportions of SCI due to “other causes” ranged from a low of 0.2% in Tianjin, China (Ning et al. 2011) to a high of 16.3% in Beijing, China (Li et al. 2011). The reported frequency of the majority of papers were between 5.3% and 11.0% (N = 16 studies). Proportions of SCI due to “struck by object” ranged from 2.0% in New Zealand (Dixon et al. 1993) to 18.6% in Beijing, China (Li et al. 2011). The majority of papers reported frequencies between 2% and 5% (N=9).
Author
|
Geographic
|
Inclusion/
|
Study population |
Injury features | Cause: %(n of cases) |
|---|---|---|---|---|---|
| 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 | Other: 8.3% |
| 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% |
Other: 1.4% |
| AlcanyisAlberola et al. 2011 N=250 |
Valencia, Spain |
Iatrogenic SCI (SCI preced by any diagnostic, surgical, pharmacological or physical therapy procedure carried out by healthcare professionals or prescribed by a physician Exclusion: patients who underwent surgery due to tumors |
Mean age=56.2 years |
Cervical=31% Thoracic=25% Lumbar=41% Sacrum=3% |
Iatrogenic SCI = 10.4% of total |
| 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 |
N = 45,442 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 |
Other: 8.0% (n=3,635) |
| 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%) |
Other: (16.3%) n=43 |
| 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% |
Other: 81-85: 3.6% 98-02: 0.0% 03-07: 1.2% |
| 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%) |
Other: (0.2%) n=2 |
| 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 |
Other: 10.4% n=2646 calculated using N traumatic SCI= 25,439) |
| 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 |
Other: 13.5% (n=126) |
| 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%) |
Other: 10.3% (n=34) |
| 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% |
Other: 8.5% (n=2,282) |
| 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% |
Other: 4.1% (n=500) |
| Qureshi et al. 2010 N=521 |
Rawalpindi, Pakistan |
All patients who suffered a spinal injury from nondisaster 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%) Complete SCI-(43%) Incomplete SCI- (33%) |
Hit by falling object: 4% (n=21) |
| 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 |
Other: 2.4% (n=6) |
| 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) |
70.1% male, 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=82Lumbar n=278 Cervical n=142 Thoracic n=48 |
Other: 0.4% (n=2) |
| Ahoniemi et al. 2008 N=1647 |
Finland | 1976-2005 Register survey; Medical records from registers of Käpylä Rehabilitation Centre |
Males = 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 |
Other: 10.0% (n=165) |
| National Spinal Cord Injury Statistical Center 2008 N=25,415 |
USA | 26 federally funded Model SCI Care Systems and National SCI Database |
Males=77.8% Average age = 39.5 years |
Incomplete tetraplegia: 34.1% Complete paraplegia: 23.0% Complete tetraplegia:18.3% Incomplete paraplegia: 18.5% |
Other: 8.1% (n=2059) |
| Fassett et al. 2007 N=412 |
Philadelphia, Pennsyl-vania, USA |
1978-2005 Treated in Delaware Valley Regional Spinal Cord Injury Center at Thomas Jefferson University Hospital |
≥70 years old | High quadriplegic (C4 and above)=42% Paraplegic=22% ASIA A ~ 45% ASIA B ~ 13% ASIA C ~ 15% ASIA D ~ 24% |
Other: 11% (n=45) |
| 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%) |
Struck by object: 9.4% (n=14) Animal related: 3.4% (n=5) |
| 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 |
Other: 7.0% (n=5) |
| 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 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) Cervical = 62% T1-T10 = 15% (35)T11-L4 = 19% (44) |
Other: 0.9% (n=2) Blunt trauma: 6.1% (n=14) (not due to MVC,falls, diving,gunshot wounds, or work-related) |
| 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). ASIAE 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 |
Other: 9% (n=13) |
| Gur et al. 2005 N=539 |
South-eastern Anatolia, Turkey |
1990-1999 4 hospitals that were major referral centers for trauma |
Males = 77.2% Average age of injury=30.62 (1- 70) years Civil servants: 22.6% (n=120) Housewives: 20.2% (n=109) Soldiers: 15.0% (n=79) |
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) |
Other: 4.8% (n=26) |
| Lakhey et al. 2005 N=233 |
Dharan, Nepal | May 1997- April 2001 Orthopaedic ward of BP Koirala Institute of Health Sciences |
Males = 72.5% <20years old =26 (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% |
Carrying load on head: 4.7% (n=11) Other: 10.7% (n=25) |
| National Spinal Cord Injury Statistical Center 2005 N=23,683 |
USA | 25 federally funded Model SCI Care Systems and National SCI Database |
Males= 79.6% Average age of injury=37.6 years |
Incomplete tetraplegia (34.5%) Complete tetraplegia (18.4%) Incomplete paraplegia (17.5%) Complete paraplegia (23.1%) |
Other: 6.8% (n=161) |
| Catz et al. 2002N=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 |
High cervical 7.6% low cervical 28.8%thoracic 32.4% lumbar 31.2% |
Violence and Sports 10.4% (n=26) |
| National Spinal Cord Injury Statistical Center 2000 N=19648 |
USA | 24 federally funded Model SCI Care Systems and National SCI Database |
Males = 81.7% 55% within 16-30 years old, mean age at injury is 31.8 years |
Complete Tetraplegia = 18.5% Incomplete tetraplegia = 29.5% Complete Paraplegia = 27.9% Incomplete Paraplegia = 21.3% |
Other: 7.9% (n=1552) |
| Caldana & Lucca 1998 N=127 |
Veneto, Italy |
1994-1995 New cases of traumatic spinal cord injury and non-traumatic spinal cord disease treated in regional hospitals (small hospitals excluded) |
Males = 83.5%; Average age (male) of 39.8 years Average age (female) of 36 years |
Cervical=62 (21 complete) Thoracic = 29 (25 complete) Thoracolumbar (T12- L1)=18(11 complete) Caudal=14 (3complete) Unidentified=1 |
Other: 0.9% (n=5) |
| 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 pediatric 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 |
Other: 5.3% (n=21) |
| Chen et al. 1997 SCI=1,586 |
Taiwan | 1992-1996 113 hospitals (11 medical centers, 50 regional general hospitals, 52 local general hospitals) |
Males = 75.0% Average age of injury=46.1 years |
Cervical 49.9% Thoracic 13.3% Lumbar 34.6% Died after treatment 6.6% (n=105) |
Struck by object: 2.1% (n=33) Other: 4.7% (n=73) |
| Exner & Meinecke 1997 N= 22,212 |
Germany | 1976-1996 All traumatic and non-traumatic SCI |
72% male. | 62% paraplegic 38% tetraplegic |
Other: 12% (n=2,665) |
| Otom et al. 1997 N=151 |
Jordan | 1988-1993 Royal Jordanian Rehabilitation Centre (RJRC) King Hussein Medical Centre (KHMC) |
Males = 85.4% Average age of injury=33 years |
Cervical=31.8% (n=48) Thoraco-lumbar= 68.2% (n=103) Frankel A= 53.6% (n=81) Frankel B = 10% (n=15) Frankel C =22.5% (n=34) Frankel D= 13.9% (n=21) |
Struck by object: 3.3% (n=5) |
| Karamehmetaglu 1995 N=152 |
Istanbul, Turkey |
1992 New patients with traumatic SCI, including pediatrics. |
Males = 75.7% Mean age = 33 years. 72% of patients were under 40. |
Tetraplegic n=50 Paraplegic n=102 |
Struck by object: 7% (n=78) |
| 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) |
Other: 7.9% (n=28) |
| 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%) |
Struck by object: 5.5% (n=536) |
| 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 patient |
Complete n=404 Incomplete n=212 Cervical spine n=155 Upper thoracic n=135 Lower thoracic n=249 Lumbar spine n=74 |
Other: 5.6% (n=34) |
| 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% 15-19 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%) |
Struck by object: 4.3% (n=16) Other: 4.0% (n=15) |
| Shingu et al. 1994 N=3465 |
Japan | 1990 Survey of nationwide institutions assumed to accept SCI patients (residents); Exclusion criteria: Traumatic cervical syndrome cases and extradural nerve root |
Mean age=47.8 years |
Cervical=126 (60.3%) Below cervical=83 (39.7%) |
Struck by object: 6.0% (n=208) |
| 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=13 Paraplegia=19 |
Struck by object: 5.3% (n=34) |
| 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%) |
Exertion/ Strain: 3.0% (n=5) Struck by object: 2.0% (n=3) |
| 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% |
Other: 10.5% (n=21) |
| 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) |
Other: 11.10% (n=188) |
| GarciaReneses et al, 1991 N=1010 |
Spain | 1984-1985 Every traumatic and non traumatic SCI patient in specialized Spanish hospitals |
72.4% male. Mean age = 41.8 ± 1.2 years. |
Sensory-motor incomplete SCI = 49% Complete SCI= 38% |
Struck by Object: 3.2% (n=32) Other: 14.1% (n=142) |
| 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% |
Other: 1.0% (n=3) Struck by object: 3.0% (n=8) Crush accident: 2.0% (n=6) |
| 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. |
Struck by Object: Incomplete tetraplegia=1 Incomplete paraplegia=1 |
Struck by object: 7.4% (n=2) Gun accidents: 14.8%(n=4) |
| 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% |
Other: 9.4% (n=19) |
| Chen et al. 1985 N=560 |
Taipei, Taiwan |
1978-1981 All record from general hospitals in Taipei. Included all spinal cord lesion with or without vertebral injury. |
Males= 86% Mean age = 35.9 (range 20-49) years. |
ncomplete Paraplegia n=118 Complete paraplegia n=180 Incomplete Tetraplegia n=117 Complete Tetraplegia n=145 Death n=31 |
Struck by object: 14.6% (n=82) Other: 5.6% (n=30) |
| Gee and Sinha 1982 N=36 |
Papua New Guinea |
1978-1981 Traumatic injury Patients that stayed in Port Moresby, Lae and Manding hospitals |
Males = 88% Mean age = 26years (range 16-41 years) |
Cervical = 22% Upper thoracic = 11% Thoraco-lumbar = 28% Lumbar = 39% |
Other: 13.9% (n=5) |
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