Articles
A demographic profile of new traumatic spinal cord injuries: Change and stability over 30 years

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Abstract

Jackson AB, Dijkers M, DeVivo M, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil 2004; 85:1740-8.

Objective

To evaluate epidemiologic trends in new spinal cord injuries (SCIs) in the United States over 3 decades.

Setting

Model Spinal Cord Injury Systems (MSCIS) facilities.

Participants

Persons (N=30,532) admitted to MSCIS facilities within 365 days of injury between 1973 and 2003, and enrolled in the National Spinal Cord Injury Database.

Interventions

Not applicable.

Main outcome measures

Data were collected at MSCIS admission and rehabilitation discharge. Variables included age, gender, race and ethnic group, year of injury, and level and extent of injury. Specific etiologies were grouped as motor vehicle collisions (MVCs), violence, falls, sports, and other. Demographic and injury severity trends were analyzed by year of injury groupings according to decades (1973–1979, 1980–1989, 1990–1999, 2000–2003.) Chi-square tests assessed statistical significance. One-way analysis of variance compared mean ages.

Results

The male/female ratio remained fairly stable at 4:1, but the percentage of women increased slightly over time, especially from MVC etiologies (P<.001). Over time, the mean age at injury increased significantly (P<.001); it was 37.7±17.5 years in 2000–2003. The majority of cases were white (66.1%). Tetraplegia (54.1%) and complete injuries (55.6%) occurred more than paraplegia and incomplete injuries, respectively. MVCs (45.6%) remained the most common etiology; falls (19.6%) held the second position over violence (17.8%), except for the 1990–1999 period when the positions were reversed. Significantly increasing percentages of new injuries were seen for SCI due to automobile, motorcycle, bicycle, and all-terrain vehicle crashes, blunt object attacks, snow skiing, and medical and surgical mishaps.

Conclusions

Many previously seen SCI demographic trends continued into the 2000 decade.

Section snippets

Methods

At the time of this study, the NSCID housed records for 30,532 persons admitted to a MSCIS within 365 days of injury between 1973 and March 2003. Eligibility criteria and changes in those criteria over time have been described previously.1, 7

The NSCID contains information on new injuries in 2 separate data sets. The Registry data set contains very limited demographic and injury severity information on persons treated at the MSCIS for whom follow-up data will not be collected. Persons enrolled

Results

Over the last 30 years, the MSCIS facilities have admitted 30,532 people who sustained a traumatic SCI and otherwise satisfied Registry or Form I dataset criteria (table 1). The average was over 1100 cases per year for the period from 1980 onward. The average was lower in the 1970s when the number of MSCIS facilities was small but expanding. Because data for the years following 2000 are limited to 4.75 years (a cutoff of data entry was made after 9mo into 2003), it is too early to determine

Discussion

With an estimated incidence around 40 cases per million, SCI is a fairly uncommon cause of disability. However, its costs, both economic and social, are out of proportion to its frequency.11, 12, 13, 14 It is thus important to review the database trends to gain understanding of the ramifications of this traumatic event. This study examines the significant trends over the past 30 years and suggests how these correspond with the trends in the general population.

One significant trend is the change

Conclusions

This new analysis of the latest trends in the epidemiology of SCI has revealed several new findings relative to the last report on this topic from the MSCIS.6 These include dramatic declines in the percentages of neurologically complete injuries, cases caused by acts of violence and certain recreational activities such as diving, along with a significant increase in the percentage of ventilator-dependent cases. A continuation in the previously reported trend toward increasing mean age at injury

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  • Cited by (0)

    Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, US Department of Education (grant nos. H133N000016, H133N000027, H133A011201).

    No commercial party having a direct interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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