The aim of this study was to determine whether there have been epidemiologic changes in acute spinal cord injury. Two groups of patients injured in the same geographic area were compared: the first group of 351 patients was injured between 1947 and 1973; and the second group of 201 patients between 1974 and 1981. The results showed that there were indeed major epidemiologic changes in spinal cord injury between the two study periods. Most importantly, the more recently injured group were younger, arrived sooner, had less severe cord injuries, and higher frequencies of motor vehicle, and sports and recreational accidents, but fewer work-related injuries.
The ThinkFirst Canada Smart Hockey program is an educational injury prevention video that teaches the mechanisms, consequences, and prevention of brain and spinal cord injury in ice hockey. This study evaluates knowledge transfer and behavioural outcomes in 11-12 year old hockey players who viewed the video.
Randomized controlled design.
Greater Toronto Minor Hockey League, Toronto Ontario.
Minor, competitive 11-12 year old male ice hockey players and hockey team coaches.
The Smart Hockey video was shown to experimental teams at mid-season. An interview was conducted with coaches to understand reasons to accept or refuse the injury prevention video.
A test of concussion knowledge was administered before, immediately after, and three months after exposure to the video. The incidence of aggressive penalties was measured before and after viewing the video.
The number of causes and mechanisms of concussion named by players increased from 1.13 to 2.47 and from 0.67 to 1.22 respectively. This effect was maintained at three months. There was no significant change in control teams. There was no significant change in total penalties after video exposure; however, specific body checking related penalties were significantly reduced in the experimental group.
This study showed some improvements in knowledge and behaviours after a single viewing of a video; however, these findings require confirmation with a larger sample to understand the sociobehavioural aspects of sport that determine the effectiveness and acceptance of injury prevention interventions.
Cites: JAMA. 1999 Dec 22-29;282(24):2328-3210612320
This report describes the results achieved in 144 patients with spinal cord injury admitted during the period 1974 to 1979 to the Acute Spinal Cord Injury Unit of Sunnybrook Medical Centre in Toronto. Several innovations have been made. These are based on a systems analysis approach to care and documentation. It includes epidemiologic studies of, and programs for, urologic and respiratory management and the use of halo devices. The unit has achieved a marked reduction in both mortality and morbidity. Patients have been transferred to the unit earlier after trauma and have been discharged earlier to rehabilitation hospitals partly because of the coordination of the acute and rehabilitation phases of care. There has been a marked reduction in the cost of care, because of fewer complications and a shorter stay in the acute hospital. The study confirms the advantages of regionalization and specialization in the field of acute spinal cord injury.
There has been an alarming increase in the number of spinal injuries in hockey players. Between 1976 and 1983, 42 were reported to the Committee on Prevention of Spinal Injuries due to Hockey. The median age of the injured players was 17 years. Of the 42 players 28 had spinal cord injuries, and 17 of them had complete paralysis below the vertebral level of the injury. Strikes from behind and collisions with the boards were common mechanisms of injury. Many of the players had suffered a burst fracture of the cervical spine following a blow to the top of the helmet when the neck was slightly flexed. The committee studied a number of possible etiologic factors and made several recommendations regarding prevention. League officials, coaches, players and equipment manufacturers can all play a role in prevention.
Cites: Clin Neurosurg. 1964;12:226-365865042
Cites: Can Med Assoc J. 1968 Dec 28;99(25):1234-95700851
Based on epidemiological data from two populations of patients with acute spinal cord injury (ASCI), three outcome measures were compared to evaluate the effectiveness of management of ASCI patients in a regional, specialized acute spinal cord injury unit (ASCIU). The two populations consisted of a pre-ASCIU group of 351 patients managed from 1947-73 before the establishment of the ASCIU, and an ASCIU group of 201 patients managed in an ASCIU from 1974-81. The three outcome measures were mortality rate, length of stay (LOS) during first hospitalization, and neurological recovery. Linear regression and multiple regression analyses were used to determine whether differences in the outcome measures were attributable to differences in admission variables in addition to the influence of the ASCIU. The results showed that the patients treated in the ASCIU had a significant reduction in the mortality rate of almost 50% (P = 0.022), a significant reduction in the LOS of almost 50% (P
In this study, we wished to examine the nature and incidence of major spinal injuries sustained by ice hockey players and to add reported cases to a permanent registry.
The study was a retrospective review of questionnaires returned by physicians reporting spinal injuries due to ice hockey.
Canada primarily, with reported cases from other nations.
Two hundred forty-one cases of fracture or dislocation of the spine have been reported.
The registry includes annual incidence and mortality incidence as well as documentation of sex, age, mechanism of injury, vertebral level of injury, neurologic deficit, type of event, and type of fracture for most cases.
Between 1982 and 1993, an average of 16.8 ice hockey related major spinal injuries were reported each year. Many of these injuries occurred to the cervical spine of players aged 16-20 years who were playing in supervised games.
Prevention programs are beginning to become effective in decreasing the number of severe injuries and the number of injuries caused by a check from behind, although there has not been a significant decrease in the total number of injuries reported annually.
To determine and assess the distribution and use of Sudden Impact, a video designed by Think First and SportsSmart Canada, to help prevent spinal cord injury caused by careless shallow water diving among teenagers in the high risk group (15-24 years old).
Survey of 92 public secondary schools in Toronto, Canada.
The heads of the physical and health education departments of the 92 secondary public schools in the Metropolitan Toronto region.
The response rate was 64% (59 schools), of which 76% (45) had actually received the video. Forty one schools (91%) of those that received the video reported using it. Eighty per cent of responding schools showed it to grade 11 students. Eighty per cent of schools with swimming pools used the video compared with only 42% of schools without swimming pools.
There is a need for improvements in the system of distribution to ensure greater use of material such as this video. These may include direct distribution to principals, continuing contact with the schools, or mandatory inclusion of diving safety into the school curriculum.
Of 144 patients with spinal cord injury admitted to the Sunnybrook Medical Centre from 1974 to 1979, 25 (24 men) (17.4%) had sustained their injuries at work. The 25 patients ranged in age from 20 to 56 years, with more than half being in their third decade of life. Work-related spinal cord injury was more frequent in the thoracic region than spinal injuries from other causes. The injuries were generally severe, 24% of them being complete cord injuries (i.e., no sensory or motor function below the level of injury). The mean neurologic grade of these patients did not change substantially between the time of admission and discharge. The mortality was 8%. The pattern of spinal cord injury in this series was compared to that in the period 1948 to 1973, when 105 (29.3%) of 358 spinal cord injuries occurred at work, constituting the second most frequent cause of acute spinal cord injury, after traffic accidents. In the current series, only 17.4% sustained their injuries at work. This was the third most common cause of spinal injuries in this period after traffic accidents and sports-recreational injuries. Falls in industry were the most frequent mode of work injury from 1974 to 1979, compared with construction accidents in the earlier period. The number of work-related spinal cord injuries is still too high. Furthermore, the severe neurologic damage suffered and the lack of substantial improvement emphasize the importance of preventive efforts, especially in industry. The fact that work injuries now rank third as a relative cause of spinal injury may indicate an absolute decline in this type of injury, especially among construction workers.