To evaluate the association between cardiovascular disease (CVD) and spinal cord injury (SCI) in a large representative sample.
Data were compiled from more than 60,000 individuals from the 2010 cycle of the cross-sectional Canadian Community Health Survey (CCHS). Multivariable logistic regression analysis was conducted to examine this relationship, adjusting for confounders and using probability weighting to account for the CCHS sampling method.
After adjusting for age and sex, SCI was associated with a significant increased odds of heart disease (adjusted odds ratio [OR] = 2.72, 95% confidence interval [CI] 1.94-3.82) and stroke (adjusted OR = 3.72, 95% CI 2.22-6.23).
These remarkably heightened odds highlight the exigent need for targeted interventions and prevention strategies addressing modifiable risk factors for CVD in individuals with SCI.
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Retrospective analysis of a prospectively collected trauma database of a Level 1 (tertiary) trauma center.
To define the features of the cervical spinal injuries in polytrauma population admitted to the regional trauma unit.
Canada, Ontario Province, Toronto, Sunnybrook Health Sciences Center.
All trauma admissions between 1987 and 1996 entered prospectively into a trauma registry database were studied for incidence, demographic and epidemiological details of cervical spine (cord and column) injuries.
A total of 468 patients (66% male) with cervical spinal injury (CSI) from 1198 spinal injuries admitted to the regional trauma center were identified. Seventy-five per cent of the CSI involved were aged less than 50 years; nearly 30% were in the third decade alone. Overall, the commonest spinal level injured was C2 (27%) followed by C5 (22%). Older population (above 60 years of age) had C1 + 2 involved more often than the young (P=0.02). Motor vehicular crashes (MVC) accounted for 71%, followed by pedestrian trauma (10%), sport injuries (7%). Spinal cord injury (SCI) was noted in 27%; complete in 16% and incomplete in 11% and more frequently at C4 or C5 level compared with C1, C2 (P
Previous qualitative and survey studies have suggested women with spinal cord injury (SCI) are screened less often for cervical cancer compared with the general population. We investigated whether cervical cancer screening rates differ between population-based women with and without traumatic SCI, matched for age and geography.
A double cohort design was used, comparing women with SCI to the general population (1:4) using administrative data for Ontario, Canada. Women with SCI, identified using the Discharge Abstract Database for the fiscal years 1995-1996 to 2001-2002, were female residents of Ontario between the ages of 25 and 66, admitted to an acute care facility with a traumatic SCI (ICD-9 CM code 806 or 952). Women in the general Ontario population were randomly matched by age and geography. Screening rates were calculated from fee codes related to Papanicolaou (Pap) smear tests for a 3-year period preinjury and postinjury.
There were 339 women with SCI matched to 1506 women in the general Ontario population. Screening rates pre-SCI were 55% for women with SCI and 57% during this same time period for matched women in the general population; post-SCI rates were 58% for both the two groups. Factors predicting the likelihood of receiving a Pap test for SCI cases included younger age and higher socioeconomic status.
Utilization data suggest that there are no significant differences in screening rates for women with SCI compared with the general population. However, screening rates for women with SCI were significantly influenced by age as well as income.
Because relevant changes in the epidemiology of the traumatic spinal cord injury (SCI) has been reported, we sought to examine the demographics, injury characteristics, and clinical outcomes of patients with spine trauma who have been treated in our spine trauma center.
All consecutive patients with acute spine trauma who were admitted in our center from 1996 to 2007 were included. Comparisons among the four triennia were performed for demographics, injury characteristics, and clinical outcomes. Also, our 2001/2002 SCI data were compared with the National Trauma Registry (NTR) dataset.
There were 569 patients (394 males, 175 females; ages from 15 to 102 years, mean age of 50 years) who were admitted with acute spine trauma. Although demographic profile has been steady over the last four triennia, the frequency of more severe spine trauma at the lumbosacral levels due to falls has increased overtime. The mean length of stay and in-hospital mortality rates have not significantly changed during the past 12 years. Our in-hospital mortality rate (4%) was significantly lower than the provincial rate from the Ontario Trauma Registry (7.5%; p = 0.005). Comparisons between our SCI data and the NTR dataset showed significant differences regarding age groups.
Our results indicate that significant differences in the characteristics of acute spine trauma but not demographics have occurred overtime in our institution. Also, there were significant differences between our database and the NTR regarding age distribution. Our reduced in-hospital mortality rates in comparison with the provincial data reinforce the recommendations for early management of SCI patients in a spine trauma center.
To describe the incidence, clinical features, and treatment of traumatic spinal cord injury (SCI) treated at a Canadian tertiary care center.
Understanding the current epidemiology of acute traumatic SCI is essential for public resource allocation and primary prevention. Recent reports suggest that the mean age of patients with SCI may be increasing.
We retrospectively reviewed hospital records on all patients with traumatic SCI between January 1997 and June 2001 (n = 151). Variables assessed included age, gender, length of hospitalization, type and mechanism of injury, associated spinal fractures, neurologic deficit, and treatment.
Annual age-adjusted incidence rates were 42.4 per million for adults aged 15-64 years, and 51.4 per million for those 65 years and older. Motor vehicle accidents accounted for 35% of SCI. Falls were responsible for 63% of SCI among patients older than 65 years and for 31% of injuries overall. Cervical SCI was most common, particularly in the elderly, and was associated with fracture in only 56% of cases. Thoracic and lumbar SCI were associated with spinal fractures in 100% and 85% of cases, respectively. In-hospital mortality was 8%. Mortality was significantly higher among the elderly. Treatment of thoracic and lumbar fractures associated with SCI was predominantly surgical, whereas cervical fractures were equally likely to be treated with external immobilization alone or with surgery.
A large proportion of injuries was seen among older adults, predominantly as a result of falls. Prevention programs should expand their focus to include home safety and avoidance of falls in the elderly.
A survey based on interviews with all Norwegian hospitals, 62 in number, showed that in 1974 and 1975 respectively 65 and 66 traumatic spinal cord and cauda equina lesions were treated in Norway, a total of 131 or 16 . 5/million inhabitants/year.
To provide national Finnish data on the incidence of traumatic spinal cord injury (TSCI) over a 30-year period.
Käpylä Rehabilitation Centre, Helsinki, Finland.
Patients aged 16 years and older who sustained a TSCI between 1976 and 2005 were identified using the registers of the Käpylä Rehabilitation Centre.
The medical records of a total of 1647 patients (1362 men and 285 women) were analyzed. The mean annual incidence rate for the entire population was 13.8/1 000 000. Age-adjusted incidence did not change among men or women during the three decades, but the mean age at injury of both men (from 34.7 to 42.4 years) and women (from 35.8 to 40.4 years) increased. The annual incidence of new TSCI rose significantly in persons 55 years and older. The proportion of tetraplegia and of incomplete injuries increased, too.
Although TSCI is predominantly present in young men, more attention for primary prevention, medical care and rehabilitation in men and women aged 55 years and older is needed. An international uniformity in methodology to collect epidemiological data of TSCI is needed.
Privacy legislation addresses concerns regarding the privacy of personal information; however, its interpretation by research ethics boards has resulted in significant challenges to the collection, management, use and disclosure of personal health information for multi-centre research studies. This paper describes the strategy used to develop the national Rick Hansen Spinal Cord Injury Registry (RHSCIR) in accordance with privacy statutes and benchmarked against best practices. An analysis of the regional and national privacy legislation was conducted to determine the requirements for each of the 31 local RHSCIR sites and the national RHSCIR office. A national privacy and security framework was created for RHSCIR that includes a governance structure, standard operating procedures, training processes, physical and technical security and privacy impact assessments. The framework meets a high-water mark in ensuring privacy and security of personal health information nationally and may assist in the development of other national or international research initiatives.
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