There were 82 studies reporting data on falls leading to SCI (table 8). 40 studies used data arising from hospital admission/discharge records which included either single or multiple hospitals. A total of 14 studies were based on national data from specifically designed SCI databases. Most of the studies were conducted in North America (Canada N=8; United States N=18) and Europe (N=24) followed by studies conducted in countries in Asia (N=20), Africa (N=5), Oceania (N=6), and South America (N=1).
The proportion of fall-related SCI ranged from a low of 2.2% in Italy (Caldana and Lucca 1998) to a high of 77.6% in Nepal (Lakhey et al. 2005). Interestingly a large proportion of the high rate of falls reported in Nepal is due to the occupational hazard of working in trees. The most commonly reported proportion of fall-related SCI was in the 20-30% range (N=27 studies) followed by the range below 20% (N=16). One likely source of variation is due to the included age groups. Samples that included all age groups tended to have a lower proportion of fall-related SCI compared to those with older adults. Studies from Japan (Shingu et al. 1995; Shingu et al. 1994) and Romania (Soopramanien et al. 1994) had higher proportions of fall-related SCI compared to other countries. The mean age of subjects in these studies tended to be older (about 40 years or more) than in the other studies.
Most recent estimates from the United States indicate falls as the second leading cause of SCI, varying from 24.5% to 27.3% (National Spinal Cord Injury Statistical Center February 2010; DeVivo and Chen 2011), and the leading cause of SCI among individuals 45 years of age and older (DeVivo and Chen 2011). In 3 studies from Canada, falls were the leading cause of SCI in one study (49.5%) (Couris et al. 2010), and the second leading cause in the other studies (16.4%; 21.2%; 28.5%) (Pirouzmand 2010; McCammon and Ethans 2011; Lenehan et al. 2012). In the Couris et al. (2010) study, falls were likely the leading cause of SCI because of the sample selection was of an adult population (mean age = 51.3 years), which is consistent with other studies from North America reporting SCIs due to falls are most prevalent among older individuals.
In Europe, falls have recently been reported as either the leading cause of SCI (45.5% in regions of Norway, 41.0% in Estonia) (Hagen et al. 2012; Sabre et al. 2012) or the second leading cause (33.9% in Turkey, 24.6% in Spain, 30.9% in Iceland) (Cosar et al. 2010; Van Den Berg et al. 2011; Knutsdottir et al. 2012). Similar to reports from North America, three European studies reported falls as the most common cause of SCI among elderly individuals.
In Asia, 5 studies reported falls to be the leading cause of SCI (Qureshi et al. 2010; Ning et al. 2011; Li et al. 2011; Wu et al. 2012; Wang et al. 2013), and 5 studies reported falls as the second leading cause (Chabok et al. 2009; Wu et al. 2011; Chhabra and Arora 2012; Ibrahim et al. 2013; Hua et al. 2013). Whereas SCI due to falls is primarily reported among older individuals in North America and Europe, falls leading to SCI in Asia are a combination of low falls among older individuals and falls from heights among working age individuals in the construction industry (Li et al. 2011). Interestingly, in a recent review, Chiu et al. (2010) identified falls from heights to be the leading cause of SCI in developing countries.