To study the causes and the rehabilitation outcome of traumatic spinal cord injury (SCI) in patients older than 60 years at the time of injury.
Forty-four patients were included.
The American Spinal Injury Association Motor Impairment Scale on admission and at discharge and the Functional Independence Measure Motor subscale at discharge were calculated retrospectively according to the patient records. The causes of injury and treatment were obtained. The MRI-scans in patients with cervical injuries during the last 5 years were evaluated.
Thirty-four patients (77%) were injured after falling from a height, 24 with cervical lesions. Thirty-five patients (80%) had incomplete lesions and they had the best outcome with regard to functional level. MR images of 15 patients with cervical lesions revealed preexisting cervical stenosis in 80%.
A high proportion of the patients had a cervical spinal stenosis and incomplete SCI; most of them regained good function.
Retrospective register study enhanced and verified by medical records.
To study whether electronic searches of discharge diagnosis are valid for epidemiological research of traumatic spinal cord injury (SCI), using the International Classification of Diseases (ICD).
Haukeland University Hospital, Bergen, Norway.
We identified all hospital admissions with discharge codes suggesting a traumatic SCI from ICD-8 to ICD-10 in the electronic database at Haukeland University Hospital, and ascertained the cases by reviewing all hospital records.
1080 patients had an ICD diagnostic code suggesting a traumatic SCI. Only 260 were verified when reviewing the hospital records. The ICD-10 codes had superior positive predictive values (PPV) and likelihood ratios (LR+) compared with the codes from ICD-8 and ICD-9. Combining seven codes from ICD-10 (S14.0, S14.1, S24.0, S24.1, S34.1, S34.3, T91.3) gave the highest sensitivity (0.83), specificity (0.97), PPV (0.88) and LR+ (30.23).
Obtaining hospital discharge diagnoses solely from electronic databases overestimates the incidence of traumatic SCI. Identification of patients using ICD-10 codes is more complicated because acute traumatic SCI and traumatic SCI sequelae are listed with several codes. The latest ICD version proved to be most reliable when identifying patients with traumatic SCI. However, ICD data cannot be trusted without extensive validity checks for either research or for health planning and administration.
To assess the incidence of traumatic spinal cord injuries (TSCIs) and TSCI incidence trends in relation to cause, age, gender, level and completeness of injury.
Spinal Cord Injury Centre of Western Denmark.
We reviewed medical records of TSCI patients admitted between 1 January 1990 and 31 December 2012. Proportions, incidence rates and incidence rate ratios were calculated for five time periods; 1990-94, 1995-99, 2000-04, 2005-09 and 2010-12, and were stratified on age, gender, cause, level and completeness of TSCI. TSCI incidence was calculated as the number of new cases divided by person-years at risk.
Included were 691 patients (males 81.9%). Within the study period, median age at time of injury rose from 29.0 to 47.5 years. The overall annual TSCI incidence during the study period 1990-94 to 2010-12 was 10.2 per million person-years at risk and varied from 8.3 to 11.8. The proportion of transport-related injuries fell from 56.9% in the first to 36.8% in the most recent time period. Fall-related injuries rose from 11.1 to 35.5%. The proportion of incomplete tetraplegia increased from 32.0% in the first to 40.5% in the last time period.
The overall TSCI incidence is low and remained stable from 1990 to 2012. The proportion of transport-related injuries fell, while age at time of injury and proportion of fall-related injuries and proportion with incomplete tetraplegia all increased.
To estimate the prevalence, predictors and impact of self-reported pain and spasticity and examine variables affecting quality of life in individuals with a traumatic spinal cord injury (SCI).
An anonymous questionnaire was sent out to individuals with a traumatic SCI. The questionnaire included questions about demographics and SCI characteristics, pain, spasticity and quality of life.
In total, 537 questionnaires were completed. Seventy-three percent reported chronic pain of which 60% used descriptors suggestive of neuropathic pain. The average pain intensity and interference were 5.6 (s.d. 2.3) and 5.0 (s.d. 2.8), respectively, on a 0-10 numeric rating scale (NRS), and 28.1% reported severe pain. Seventy-one percent reported spasticity. Average interference of spasticity was 2.9 (s.d. 2.7). Quality of life scores were 6.5 (s.d. 2.5) for life and life situation, 5.5 (s.d. 2.6) for physical health and 6.7 (s.d. 2.6) for mental health on the NRS (0-10). Female gender was associated with lower mental health scores and tetraplegia with lower physical health scores, and high pain interference and shorter time since injury were associated with lower quality-of-life scores for all three parameters. Pain with descriptors suggestive of neuropathic pain was associated with lower quality-of-life scores than pain without such descriptors.
Chronic pain and spasticity are common problems after SCI, and in particular, high pain interference is associated with lower quality of life.
The objective of this study was to examine how satisfied patients with traumatic spinal cord injury (TSCI) are with their general practitioners (GP).
The study included patients with TSCI, injured in the period 1982-2001 and living in western Norway. We performed a structured telephonic interview of the patients in the period 2004-2007. A total of 105 (59.3%) patients participated.
Patients with TSCI were in general satisfied with their GP. Older patients were most satisfied, and patients with incomplete thoracic SCI were least satisfied. Patients with anxiety and/or depression reported low satisfaction with their GP on several parameters.
Patients with incomplete SCI were least satisfied probably because their physicians do not acknowledge their complicated medical complaints and do not meet the patient's expectations. Patients with anxiety and/or depression were more likely to report low satisfaction with their GP.
BACKGROUND: We wanted to study the cause and the segmental level of traumatic spinal cord injuries. MATERIAL AND METHODS: All 238 patients (208 men) with traumatic spinal cord injuries admitted to the Department of Neurology, Haukeland University Hospital in Bergen, Norway, from 1952 to 1999 were included. Data were obtained from medical files and studied retrospectively. RESULTS: The initial clinical level of injury was the cervical spine in 50% of the patients, the thoracic spine in 33%, and the lumbar spine in 18%. Falling (45%) and road accidents (35%) were the main causes. The mean annual number of patients with traumatic spinal cord injuries increased from three in 1952-60 to eight in 1991-99; there was an increase in high cervical injuries among those older than 60. The proportion of work-related traumatic spinal cord injuries was 42% in 1952-74 and 26% in 1975-99. INTERPRETATION: Although there has been a reduction of work-related spinal cord injuries, there is still a potential for further prevention, especially among persons of more than 60 years of age.
The objective of this study is to assess the temporal trends in the incidence and demographic characteristics of traumatic spinal cord injury (TSCI) among children and adolescents in a geographically defined cohort in western Norway during 1952-2001.
The patients included in this study were identified from the hospital records.
Of 336 patients, 13 (3.9%) patients were 0-14 years at time of injury, and 44 (13.1%) patients were 15-19 years at time of injury. The average age-adjusted incidence was 2.4 per million children and 25.1 per million adolescents. Children were injured in car and pedestrian accidents, whereas adolescents were injured in car and motorcycle accidents.
The age-adjusted incidence of TSCI among the adolescents increased, whereas the age-adjusted incidence among children remained low during the 50 years. TSCI was highly associated with car and pedestrian accidents among children. Among adolescents, TSCI was associated with car and motorcycle accidents. Awareness of these factors is important in prevention planning strategies.
The aim of the study was to compare the incidence, causes, severity and mortality of traumatic spinal cord injury (TSCI) in Western Norway and Estonia from 1997 to 2001.
The patients were identified from hospital records. All patients were followed until death or 14 October 2011. Analysed data included demographic data, causes of injury, neurological level, American Spinal Injury Association Impairment Scale and mortality.
A total of 71 patients in Western Norway and 244 in Estonia were included. The standardized incidence rate per million was 24.9 (CI 95%, 19.4-31.7) for Western Norway and 37.4 (CI 95%, 32.8-42.5) for Estonia. Falls was the most frequent cause of TSCI in both countries. The incidence of TSCI was highest among men in their 20s in Estonia and men in their 70s in Western Norway. The median survival time among the deceased was 4.0 (95% CI, 1.50-6.50) years in Norway and 2.8 (95% CI, 1.54-4.04) in Estonia. The mean standardized mortality ratio (SMR) was 5.00 (95% CI, 4.00-6.20) in Estonia and 1.89 (95% CI, 1.23-2.77) in Western Norway.
Although the two cohorts had similar demographic, injury and clinical characteristics, the age profile of the victims was different. The incidence rate was 1.5 times higher and SMR was 2.7 times higher in Estonia. Probable explanations for the different outcomes of the two European countries are socioeconomic differences, lower physical activity level, lower life expectancy and insufficient injury prevention programmes in Estonia.