急性重度颈脊髓损伤患者临床特征及早期死亡的危险因素分析

目的 探讨重度创伤性颈脊髓损伤患者临床特点及早期死亡的危险因素.方法 分析2015年1月-2020年5月在本院治疗的急性重度外伤性颈脊髓损伤患者457例,按照早期死亡(30 d内)与否分为观察组和对照组,统计其性别、年龄、体质量指数、致伤因素、损伤节段、AISA分级、合并伤、基础疾病、是否手术、手术时机等指标,纳入Logistic回归分析探讨其早期死亡危险因素.结果 457例患者30 d以内死亡83例,病死率为18.16％,单因素分析发现:年龄、损伤节段、APACHEⅡ评分、受伤至手术时间、肺部感染、气管插管、低钠血症、血白蛋白等因素的组间差异有统计学意义(P<0.05).多因素分析发现,低白蛋白血症(OR=1.906,P=0.016),高APACHEⅡ评分(OR=9.643,P=0.004),肺部感染(OR=4.976,P=0.038),高损伤节段(OR=10.933,P=0.045),低钠血症(OR=2.103,P=0.021)是急性重度颈脊髓损伤患者早期死亡的危险因素,及早手术(OR=0.887,P=0.013)是其保护性因素.结论 高损伤节段、APACHEⅡ评分、肺部感染等反映病情严重程度和并发症的相关指标,对患者早期死亡的预测具有重要意义,而及早手术能够降低早期死亡率.     

脊髓损伤患者后期并发症及其相关因素探讨

目的:统计脊髓损伤患者后期并发症发生情况并探讨其相关因素。方法:对318例脊髓损伤患者进行3~15年跟踪随访,内容包括泌尿系并发症、呼吸系并发症、压疮、慢性顽固性肢体疼痛等,统计并发症发生情况、死亡原因,分析并发症与脊髓损伤程度、是否行手术治疗及损伤节段等的关系。结果:脊髓损伤患者后期主要并发症是泌尿系并发症,发生率为82.4%,其中泌尿系感染52.8%、慢性肾功能衰竭14.5%、肾盂积水10.5%、尿路结石5.0%;其次为慢性顽固性肢体疼痛,为64.2%;压疮为47.5%;呼吸系感染为34.3%,其它并发症有关节僵硬变形、异位骨化等。完全性脊髓损伤患者并发症发生率高于不完全性脊髓损伤患者(P<0.05),手术治疗组与非手术治疗组相近(P>0.05)。胸腰段脊髓损伤患者的泌尿系感染、压疮及肢体疼痛的发生率较其它节段损伤者高(P<0.05)。死亡28例,占8.8%,死亡主要原因是慢性肾功能衰竭,占46.4%,压疮合并感染占21.4%,呼吸系感染占14.3%。结论:脊髓损伤后期并发症发生率仍然很高,其发生率与外科手术无关。提高康复意识与水平以及全社会的支持是预防并发症、提高患者生存质量与延长寿命的关键。     

脊髓损伤并发肌痉挛的相关影响因素分析

目的 明确肌痉挛的流行病学特征、分析脊髓损伤并发肌痉挛的保护性或危险性因素。方法 回顾性分析自2019-01—2022-12于贵州医科大学附属医院康复医学科住院治疗的183例脊髓损伤患者,根据脊髓损伤有无合并肌痉挛分为痉挛组和非痉挛组,分别对两组患者的年龄、性别、病程、脊髓损伤节段、损伤分级,以及是否合并贫血、低蛋白血症、神经病理性疼痛、下肢深静脉血栓形成等数据进行分析,进一步分析脊髓损伤后肌痉挛的类型、发生特点、影响因素等特征。结果 痉挛组(n=47)和非痉挛组(n=136)的损伤节段、病程差异有统计学意义(P<0.05),但在性别、年龄、ASIA分级方面差异无统计学意义(P>0.05)。两组合并压疮情况差异有统计学意义(P<0.05),在合并神经病理性疼痛、下肢深静脉血栓形成、贫血、低蛋白血症、D-二聚体升高、尿路感染、肾积水方面差异无统计学意义(P>0.05)。Logistic回归分析结果显示损伤节段、病程、压疮均为脊髓损伤合并肌痉挛的独立影响因素,其中病程较长及合并压疮为独立危险因素(OR>1),低损伤节段为保护因素(OR<1)。结论 病程、...     

颈脊髓损伤早期死亡临床研究

目的分析研究颈脊髓损伤(CSCI)早期死亡情况,探讨颈脊髓损伤早期死亡的主要影响因素及发生机理。方法收集整理2004-02-2012-02入院的131例CSCI患者的临床资料(早期死亡15例),分析CSCI早期死亡者的年龄、性别、受伤原因、脊柱损伤节段、脊髓损伤严重程度、是否手术及气管切开、是否存在低钠血症、是否存在低蛋白血症与CSCI早期死亡的关系,总结CSCI早期死亡的原因。结果 CSCI早期死亡率为8.40%(11/131),多死于呼吸功能衰竭。性别、受伤原因及是否手术统计分析,差异无统计学意义(P>0.05);颈髓不同损伤程度、颈髓不同损伤节段、不同年龄段、气管是否切开、是否存在低钠血症及是否存在低蛋白血症统计分析,差异有统计学意义(P<0.05或P<0.001)。结论呼吸衰竭是CSCI早期死亡的首要原因;颈髓不同损伤程度、颈髓不同损伤节段、不同年龄段、气管是否切开、是否存在低钠血症、是否存在低蛋白血症是CSCI早期死亡的主要影响因素。     

完全性颈脊髓损伤患者早期发生低钠血症的多因素分析

目的探讨导致急性完全性颈脊髓损伤患者早期出现低钠血症的相关因素。方法回顾性分析2010年1月~2015年12月完全性颈脊髓损伤患者49例临床资料。以连续2次(间隔24 h)血钠135 mmol/L为低钠血症的诊断标准,合并低钠血症的26例为低钠血症组,未合并低钠血症的23例为对照组。对年龄,性别,颈脊髓损伤最高节段、损伤程度,是否使用糖皮质激素治疗,是否合并神经源性休克,平均每日尿量,平均每日液体平衡量,转入危重医学科时血钠水平和血浆白蛋白水平共10项指标进行单因素分析,单因素分析有统计学意义(P0.05)的指标再进行logistic逐步回归分析。计量资料单因素分析有统计学意义的指标通过绘制ROC曲线确定其最佳临界点。结果单因素分析中,2项指标在2组间有统计学差异(P0.05),低钠血症组患者低钠血症发生前神经源性休克发生率为57.7%(15/26),对照组为26.1%(6/23)(χ~2=6.516,P=0.011);低钠血症组患者平均每日尿量(2225±389)ml,对照组(1936±289)ml(t=2.924,P=0.005)。logistic逐步回归分析显示这两项因素均为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素(OR=13.708、0.996,P=0.004、0.002)。ROC曲线显示平均每日尿量的最佳临界点为2331 ml。结论并发神经源性休克与平均每日尿量2331 ml为完全性颈脊髓损伤患者早期发生低钠血症的独立影响因素。     

脊髓损伤后髋关节周围异位骨化的危险因素分析

目的：探讨脊髓损伤后髋关节周围发生异位骨化的危险因素。方法：将1023例外伤性脊髓损伤患者根据X线检查和CT检查分为异位骨化组（A组，121例）和无异位骨化组（B组）。比较两组患者的年龄、性别、脊髓损伤情况、脊髓损伤到瘫痪肢体开始功能训练的时间、血清钙浓度、痉挛及压疮发生情况，分析与异位骨化相关的危险因素。结果：异位骨化发生率为11．8％。A组与B组患者的年龄、性别、脊髓损伤至瘫痪肢体开始功能训练的时间、血清钙浓度及压疮发生率经统计学比较无显著性差异（P〉0．05）。A组患者中完全性瘫痪者及痉挛性瘫痪者比例较高，与B组比较差异非常显著（P〈0．01）。A组患者脊髓损伤主要位于颈段及中胸段，与B组比较有非常显著性差异（P〈0．01）。A组患者脊髓损伤主要为ASIA A级和B级，与B组比较有非常显著性差异（P〈0．01）。痉挛性瘫痪改良Ashworth Ⅱ级以上者异位骨化发生率较高，统计学比较差异非常显著（P〈0．01）。结论：完全性脊髓损伤及痉挛性瘫痪是脊髓损伤后异位骨化发生的主要危险因素。脊髓损伤神经功能分级为ASIA A级和B级者、颈段或中胸段脊髓损伤者及痉挛性瘫痪改良Ashworth Ⅱ级以上者易发生异位骨化。     

脊髓损伤后神经源性异位骨化的危险因素分析

目的分析脊髓损伤后发生神经源性异位骨化(neurogenic heterotopic ossification,NHO)的相关危险因素。方法前瞻性采集并分析2008年1月至2014年1月符合纳入标准的脊髓损伤致截瘫患者150例,利用高频超声检查髋关节是否出现NHO,将患者分为NHO组和非NHO组。记录并比较两组患者的年龄、性别、痉挛、压疮、血浆α2-HS糖蛋白、血清骨成型蛋白、血清D-二聚体、血清C-反应蛋白及血清钙离子含量、脊髓损伤节段及程度。采用多因素Logistic回归分析脊髓损伤后发生NHO的相关危险因素。结果 56例(37.33%)患者发生NHO。单因素分析示,两组间年龄、血浆α2-HS糖蛋白、血清骨成型蛋白、血清D-二聚体、血清C-反应蛋白、血清钙离子水平、压疮和脊髓损伤程度差异有统计学意义。多因素Logistic回归分析结果发现:NHO组患者的α2-HSG浓度较非NHO组显著降低,OR值为0.929(95%CI:0.887,0.973)。结论脊髓损伤患者血浆α2-HSG浓度下降是发生NHO的独立危险因素。血浆α2-HSG浓度越低,越易发生NHO。     

外伤性胸腰脊髓损伤住院患者并发症及危险因素分析

目的 探讨外伤性胸腰脊髓损伤住院患者的并发症及其危险因素.方法 回顾性分析外伤性胸腰脊髓损伤222例的情况,观察其并发症并分析危险因素.结果 共222例患者,44例发生并发症.泌尿、呼吸系统并发症和褥疮、电解质紊乱最常见,ASIA运动评分越低、住院时间越长并发症发生率越高.结论 胸腰脊髓损伤的严重程度是并发症的独立风险因素,早期手术治疗、甲基强的松龙冲击治疗不增加并发症发生率.     

颈前路手术后出现早期并发症的相关因素分析

目的探讨颈前路手术后出现早期并发症的相关因素,为临床提供参考。方法回顾性分析我科2011-05-2015-05行颈前路手术治疗的173例患者,其中18例发生早期并发症,包括颈前血肿3例,吞咽困难8例,脑脊液漏4例,内固定移位2例,神经根损伤1例,总发生率为10.4%。现将此18例作为有并发症组,未出现术后早期并发症的另155例作为无并发症组,进行相关因素的统计学分析。结果单因素分析显示,在性别、平均年龄、BMI指数和高血压、糖尿病、吸烟、酗酒、疾病类型、手术节段、手术方式、手术时间和出血量等指标的单因素分析中,平均年龄、手术节段在两组之间有显著的统计学意义(P0.05);多因素Logistic回归分析也证实,平均年龄、手术节段是两项独立的危险因素。结论年龄和手术节段是影响颈前路手术后早期并发症的独立危险因素,患者年龄越高、手术节段为C_(3-4)节段者,术后发生早期并发症的可能性越高,应引起临床重视。     

创伤性颈脊髓损伤患者低钠血症的发生率及相关因素

目的 探讨本地区创伤性颈脊髓损伤(traumatic cervical spinal cord injury, TCSCI)患者低钠血症的发生率及影响因素。方法 选择2019年1月～2021年12月在该院就诊的TCSCI患者资料进行回顾性分析,记录患者的年龄、性别、损伤原因、严重程度(完全或不完全性脊髓损伤)和脊髓损伤水平、血清钠水平、治疗策略及低钠血症持续天数,观察是否低钠血症患者的临床资料差异。结果 共有54例发生低钠血症,发生率为58.06%。单因素分析显示,低钠血症和非低钠血症患者性别、损伤原因、白蛋白水平差异均无统计学意义(P>0.05);两组患者年龄、损伤平面、ASIA分级、甲强龙冲击、神经源性休克、体温、合并感染、每日尿量等差异存在统计学意义(P<0.05)。多因素Logistic回归分析显示,完全性脊髓损伤和神经源性休克是TCSCI患者发生低钠血症的风险因素(P<0.05)。结论 TCSCI后低钠血症发生率为58.06%,完全性脊髓损伤和神经源性休克是TCSCI患者发生低钠血症的风险因素,临床应早期监测TCSCI发生后的钠离子水平,以早发现、早期干预治...     

The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury

Context/Objectives: To determine the impact of spasticity presenting during the acute care hospitalization on the rehabilitation outcomes following a traumatic spinal cord injury (TSCI).

Design: Retrospective cohort study.

Setting: A single Level 1 trauma center specialized in SCI care.

Participants: 150 individuals sustaining an acute TSCI.

Interventions: Not applicable.

Outcome Measures: The total inpatient functional rehabilitation length of stay. The occurrence of medical complications and the discharge destination from the inpatient functional rehabilitation facility were also considered.

Results: 63.3% of the cohort presented signs and/or symptoms of spasticity during acute care. Individuals with early spasticity developed medical complications during acute care and during intensive functional rehabilitation in a higher proportion. They were also hospitalized significantly longer and were less likely to return home after rehabilitation than individuals without early spasticity. Early spasticity was an independent factor associated with increased total inpatient rehabilitation length of stay.

Conclusion: The development of signs and symptoms of spasticity during acute care following a TSCI may impede functional rehabilitation outcomes. In view of its association with the occurrence of early spasticity, higher vigilance towards the prevention of medical complications is recommended. Early assessment of spasticity during acute care is recommended following TSCI.     

Spinal epidural abscess: study of early outcome

OBJECTIVE: To evaluate the course, complications, and outcomes of individuals with spinal epidural abscess (SEA) and to compare these factors in individuals who had sustained a traumatic spinal cord injury (TSCI). METHOD: This is a retrospective study evaluating risk factors, functional change, and neuromedical complications. Thirty-two adults with SEA, treated on a rehabilitation unit at an urban university medical center, were compared with 32 individuals with TSCI. Groups were matched by lesion level and American Spinal Injury Association classification. RESULTS: Both groups made significant functional improvement as measured by the functional independence measure (FIM), although the SEA group only averaged a 15-point increase, whereas the TSCI group averaged approximately 30 points. When compared with the TSCI group, the SEA group had a higher frequency of pressure ulcers (P < 0.04), and exhibited greater intravenous drug use (P < 0.008). There were no differences between the groups with respect to discharge placement or neuromedical risk factors. CONCLUSION: A number of predisposing factors and neuromedical complications that have significant medical implications were noted in the SEA group. In general, predisposing factors and outcomes were similar between those with SEA and those with TSCI, except for drug use and rate of pressure ulcers. These factors do not appear to relate to differential outcome in discharge placement, however. Although it is important to be aware of factors that place an individual at risk for SEA and appreciate the risks for complications, significant functional improvement can be achieved in this population.     

Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization

Objective: To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications.

Design: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed.

Setting: Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway

Participants: A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI.

Outcome measures: Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared.

Results: Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay.

Conclusions: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation.     

Mortality and causes of death after traumatic spinal cord injury in Estonia

Abstract

Study design

Retrospective population-based study with mortality follow-up.

Objective

To study mortality, causes and risk factors for death in Estonian patients with traumatic spinal cord injury (TSCI).

Setting

All Estonian hospitals.

Methods

Medical records of patients with TSCI from all regional, central, general, and rehabilitation hospitals in Estonia from 1997 to 2007, were retrospectively reviewed. Mortality status was ascertained as of 31 December 2011. Causes of death were collected from the Estonian Causes of Death Registry. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. A Cox proportional hazards modeling was used to identify the risk indicators for death.

Results

During the observation period (1997–2011) 162 patients of 595 died. Nearly half of the patients (n = 76) died during the first year after TSCI. The main causes of death were external causes (30%), cardiovascular disease (29%). and suicide (8%). The overall SMR was 2.81 (95% confidence interval 2.40–3.28) and SMR was higher for women than for men (3.80 vs. 2.70). Cause-specific SMRs were markedly elevated for sepsis and suicide. Mortality was significantly affected by the age at the time of injury, neurological level, and extent of the injury as well as the year of TSCI and complications.

Conclusion

Life expectancy is significantly decreased in patients with TSCI in Estonia compared with the general population. Deaths during the first year after the injury have an important impact on statistics. Treatment of cardiovascular diseases, infections, and prevention of suicide are useful for reducing mortality in patients with TSCI.     

Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations of Saskatchewan: a prospective outcomes study

BackgroundPeople of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay.MethodsThis was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations.ResultsOf the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly.ConclusionThis study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.     

Acute traumatic spinal cord injury, 1993-2000A population-based assessment of methylprednisolone administration and hospitalization

BACKGROUND: Administration of methylprednisolone sodium succinate (MPSS) after acute traumatic spinal cord injury (TSCI) is controversial. This study compared differences in acute care charge, hospital stay, and related variables as a function of MPSS receipt. METHODS: Determinants of MPSS administration were examined after acute TSCI for South Carolina patients during the period 1993 to 2000 in a multivariate logistic regression model. RESULTS: Administration of MPSS was documented for 48.7% of 1,227 randomly selected patients with TSCI. Patients admitted via trauma centers and emergency departments were more likely to receive MPSS (trama center level 1 odds ratio [OR], 4.06; 95% CI confidence interval [CI], 2.11-7.83; emergency department OR, 1.64; 95% CI, 1.20-2.23). Hospital charge and length of stay were significantly higher for MPSS recipients. CONCLUSIONS: The study findings indicate MPSS use is associated with higher acute care charges and longer hospital stays. These findings suggest the need for outcome studies to assess the long-term benefits of MPSS administration.     

Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury

ObjectivesIdentifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team.DesignProspective cohort study.SettingA single Level-1 trauma center specialized in SCI care.ParticipantsA cohort of 301 patients with acute TSCI was studied.Outcome measuresThe primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors.ResultsWhen controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1–4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001).ConclusionsPrevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.     

The comparison of recovery patterns between ischemic spinal cord injury and traumatic spinal cord injury from acute to chronic phase

Objective: To investigate the neurological and functional recovery patterns of ischemic spinal cord injury (ISCI) compared with traumatic spinal cord injury (TSCI) in the acute to chronic phase.Design: Retrospective cohort study.Settings: Department of Neurology, Neurosurgery, Rehabilitation Medicine at a tertiary hospital.Participants: Fifty-four patients with ISCI and 86 patients with TSCI.Interventions: Not applicable.Outcome measures: MRI findings, American Spinal Injury Association Impairment Scale (AIS), modified Rankin Scale (mRS), Korean Spinal Cord Independence Measure (KSCIM), ambulatory status, and bladder status were reviewed. The functional outcomes were measured at admission, discharge, and >6 months after discharge.Results: AIS classification did not significantly change after 6 months in both ISCI and TSCI groups. Between admission and discharge, the proportion of patients needing a wheelchair or assistive device to ambulate decreased more in the ISCI group compared with the TSCI group [odds ratio (OR) 0.40, P = 0.04]. In addition, the proportion of catheterized voiding in the ISCI group was significantly higher than in the TSCI group at all time points (OR 5.12, P < 0.001). Lastly, both groups showed that functional improvement was the greatest between admission and discharge. In addition, the proportion of catheterized voiding decreased (Diff = −0.12, P = 0.019) and mRS score decreased (Diff=−0.48, P < 0.001) significantly in the ISCI group at >6 months post discharge.Conclusion: The ISCI group showed better recovery of mobility during inpatient rehabilitation period and worse recovery of bladder function as demonstrated by higher number of patients requiring bladder catheterization at all time points when compared with the TSCI group.     

High incidence of traumatic spinal cord injury in Estonia

Study design:Retrospective population-based cohort study.Objectives:To provide national data on epidemiology of traumatic spinal cord injury (TSCI) among the population of Estonia from 1997 to 2007.Setting:All Estonian hospitals.Methods:Medical records of patients with TSCI from all regional, central, general and rehabilitation hospitals in Estonia were retrospectively reviewed. Epidemiological characteristics, etiology, neurological level and severity of injury, concomitant injuries were analyzed.Results:A total of 595 patients with TSCI from 1 January 1997 to 31 December 2007 were identified. The male to female ratio was 5.5:1. The mean age at injury was 39.0 years. The crude incidence rate was 39.7 (95% confidence interval: 36.6-43.0) per million population. The most frequent cause of TSCI was falls (41%), followed by traffic accidents (29%). Alcohol consumption preceded 43% of injuries. The lesion level was cervical in 59.4%, thoracic in 18.3% and lumbar/sacral in 22.3%.Conclusion:Compared to recent studies from Europe, where the incidence of TSCI is between 15 and 30 per million population, the incidence of TSCI in Estonia is among the highest. The rates are significantly higher in men compared with women and especially among the youngest men. The leading cause of TSCI is falls. A significant proportion of injuries are related to alcohol consumption before trauma in Estonia.     

Epidemiological features of traumatic spinal cord injury in Chongqing,China

Objective: To describe the epidemiological characteristics and trends of traumatic spinal cord injury in Chongqing, China.

Study design: Hospital-based retrospective research.

Setting: Xinqiao Hospital, Chongqing.

Methods: We reviewed medical records of 554 patients with traumatic spinal cord injury (TSCI) admitted to Xinqiao Hospital from 2009 to 2013. Variables included gender, age, marital status, etiology, occupation, time of injury, level of injury, and severity of injury, the length of hospital stay, and treatment.

Results: The mean age of patients with TSCI was 45.6 ± 13.8 years, and the male/female ratio was 4.33:1. 94.2% (522 patients) of all patients with TSCI were married. Falls, comprising low falls and high falls (10.8% and 50.9%, respectively), were the leading reason for a hospital visit. And the second reason was MVCs (21.8%). The most common injury site was the cervical spinal cord, accounting for nearly more than 54%. The length of hospital stay ranged between 1 and 219 days (mean: 28.3 days). The proportions of complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia were 17.1%, 37.8%, 22.2%, and 22.9%, respectively.

Conclusion: The result revealed that the proportion of males was higher, as well as falls and MVCs were the first two main reasons, with older mean age of patients with TSCI than other countries. The occupations with highest risk for TSCI were peasants and laborers. All of these results prompted that preventive methods should be based on the characteristics of different type of patients with TSCI.