Epidemiology of Traumatic SCI

Work-Related Incidents

There were 17 papers reporting on SCI due to work-related accidents (Table 12). Fifteen papers used admission data from one or multiple hospitals; one paper used data from a SCI registry. Studies on SCI due to work-related accidents came from Europe (N=4), Oceania (N=3), North America (N=4), Asia (N=4), South America (N=1) and Africa (N=1).

Proportions of SCI due to work-related injuries ranged from a low of 0.8% in Tinajin, China (Ning et al. 2011) to a high of 26.8% in Israel (Catz et al. 2002). Seven studies reported specific types of work leading to SCI with industrial work such as mining, forestry, farming as most frequent (Dixon et al. 1993; Tator et al. 1993; Stavrev et al. 1994; Igun et al. 1999; O’Connor 2001; Singh et al. 2003, McCammon and Ethans 2011). There was one paper reporting on SCIs specifically due to work- related accidents in Chile (Correa et al. 2011). The average annual incidence was 7.8 per million workers in Chile from 1986 to 2005. The 2005 prevalence rate was 112 cases per million workers. The most frequently affected ages ranged from 25 to 34 years. Cause of SCIs in the Chilean workplace included falls, being struck by objects, and MVCs (Correa et al. 2011).

Table 12. Work-Related Incidences

Author Year N of study population	Geographic region	Inclusion/ exclusion criteria	Study population	Injury features	Cause: %(n of cases)
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%	Work Related: 2.1%
Correa et al. 2011 N=173	Chile	1986-2005 Patients with traumatic SCI incurred in the workplace admitted to Hospital del Trabajador in Santiago, Santiago, Chile	99.4% (172) male Age at TSCI onset was 38.2±12.1 years.	78 (45.1%) – complete paraplegia 54 (31.2%) – incomplete paraplegia 18 (10.4%) -complete tetraplegia 23 (13.3%) – incomplete tetraplegia.	Work-related incidents: Falls from a height-49.7% (86 cases) Trauma blows to the vertebral spine – 35.3% (61 cases) Traffic accident – 8.7% (15 cases) Other causes – 6.4% (11 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%	Work: 81-85: 3.6% 98-02: 2.6% 03-07: 4.0%
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%)	Work-related incident: 0.8% (n=7)
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%	Work-related: 6.6% (n=10)
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%	Work-related 10.3% (n=6)
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.	Males = 74.7%) Mean age at injury=35.4 years	164 tetraplegia 283 paraplegia	Mine cave-in: 6.42% (n=31)
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%	Work-related: 26.8% (n=34)
O’Connor 2001 N=369	Australia	1986-1997 Australian Spinal Cord Injury Register	Males= 95% 75% aged 25-54 years 28% labourers (construction, mining)	Data for 358 subjects: 35% incomplete paraplegia 34% complete paraplegia 21% incomplete tetraplegia 10% complete tetraplegia 34.4% (n=123) cervical 45.5% (n=163) thoracic 23.2% (n=83) lumbar	Work-related: 13% (n=369)
van Asbeck et al. 2000 N=126 (specific data for 113)	Netherlands	1994 Patients with SCI in National Registration system with medical records. 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%)	Work-related: 4.4% (n=5)
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	Mining cave-in 17.96% (n=12)
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 (male) of 39.8 years Average age (female) of 36 years	Cervical=62 (21 were complete) Thoracic=29(25) Thoracolumbar (T12- L1)=18(11) Caudal=14(3) Unidentified=1	Work-related: 22% (n=28)
Exner and Meinecke 1997 N= 22,212	Germany	1976-1996 All traumatic and non-traumatic SCI	72% male.	62% paraplegic 38% tetraplegic	Work-related: 14% (n=3119)
Stavrev et al. 1994 N=980	Plovdiv and Plovdiv region, Bulgaria	1983-1992 Treatment for SCI at 2 clinics in Plovdiv region	Males=72% 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%)	Work-related: 7.2% (n=71)
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%)	Work-related: 3% (n=5)
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; 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%	Work-related: 13.9% (n=28)
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%)	Work-related: 9.4% (n=19)