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Epidemiology of Traumatic SCI

Self-Harm

There were 21 papers reporting on SCI as a result of self-harm (Table 11). The majority of the studies used admission data (N=13 studies) from one or multiple hospitals; one study used an SCI-specific registry, and another used a national health database (Wu et al. 2011). Eight studies were conducted in Europe; five studies were from each of North America and Asia, and one from Oceania.

Proportions of SCI caused by self-harm ranged from a low of 0.4% in Manitoba, Canada (McCammon and Ethans 2011) to a high of 25.9% in Greenland (Pedersen et al. 1989). Thirteen studies reported SCI due to self-harm in the range of 0.4% to 4.5%. In addition to Greenland, two other countries reported relatively higher proportions of self-harm as SCI cause: Finland with 10% (Dahlberg et al. 2005) and Israel with 13.6% (Catz et al. 2002). All three countries with high proportions of SCI due to self-harm also reported high frequencies of suicide

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

population

Injury features Cause: %(n of

cases)

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%
Self Harm:
81-85: 0.0%
98-02: 1.0%
03-07: 0.4%
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
Attempted
suicide:
(2.3%)
n=574
calculated using
N traumatic
SCI= 25,439)
Stanford et al.
2007
N=2,752
Sydney,
Australia
1970-2000
All SCI injuries with
neurological deficits
and documented
evidence of self-harm
in New South Wales,
Australia
36 males; Median
age =30 (range
15-74) years
ASIA A n=23
ASIA B n=7
ASIA C n=4
ASIA D n=22
Self-Harm:
2.6% (n=72)
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%
Self-Harm:
1.3% (n=2)
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
Self-Harm: 10%
(n=15)
Gur et al.
2005
N=539
Southeastern
Anatolia,
Turkey
1990-1999
4 hospitals that were
major referral centers
for trauma
Males = 77%
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)
Self-Harm:
2.8% (n=15)
Martin et al.
2005
N=563
(SCI=13)
USA All patients from the
National Trauma Data
Bank (2002) with a
diagnosis of hanging
injury, and survival to
admission.
Males=65%
Mean age
=30.4±13.1
years.
13 patients had SCI:
12 cervical
1 thoracic
Self-Harm:
3% (n=13)
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
Males= 71.6%
Median age of
injury=35.0 years
61.5% (n=277) cervical
17.3% (n=78) thoracic
17.1% (n=77)
lumbar/sacral/cauda
equina
4.0% (n=18) unspecified
Self-Harm:
2.0% (n=9)
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%)
Self-Harm:
4.4% (n=30)
Pickett et al.
2003
N=2385
Ontario,
Canada
1994-1999
SCI in Ontario
Trauma Registry
Males= 59%
<20 years =2
(11%)
20-39 years= 19
(56%)
40-59 years=13
(25%)
≥60 years=4 (8%)
No details Self-Harm:
1.4% (n=33)
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%
Self-Harm:
13.6% (n=34)
Exner &
Meinecke
1997
N= 22,212
Germany 1976-1996
All traumatic and nontraumatic SCI
72% male. 62% paraplegic
38% tetraplegic
Self-Harm:
5% (n=1080
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)
Self-Harm:
0.7% (n=1)
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)
Self-Harm:
4.0% (n=14)
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%
Self-Harm:
1.7% (n=166)
Silberstein &
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.
183 males. 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
Self-Harm:
3.1% (n=6)
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
Males (overall) =
81.2%
Mean age (selfharm) =31.3
years
Cervical=14 (23%)
Below cervical=46 (77%)
Self-Harm:
1.7% (n=59)
Lan et al.
1993
N=99
Hualien,
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 paraplegia=1
Incomplete paraplegia=1
Self-Harm:
2.0% (n=2)
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%
Self-Harm:
8% (n=21)
Pedersen et
al.
1989
N=27
Greenland 1965-1986
Admissions to
rehabilitation hospital
in Hornback with
traumatic SCI;
Patients injured in
Greenland.
Males=74%
Mean age=33.5
(14-50) years.
Complete paraplegia=5
Incomplete paraplegia=2
Self-Harm:
25.9% (n=7)
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
Incomplete Paraplegia
n=118
Complete paraplegia
n=180
Incomplete Tetraplegia
n=117
Complete Tetraplegia
n=145
Death n=31
Self-Harm:
1.4% (n=8)
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