1. The incidence rate of traumatic spinal cord injury has remained stable from 1993 to 2012, with elderly persons experiencing a high rate of increase in incidence, likely associated with falls, and the younger male population experiencing a decline in incidence rate.
2. Acute inpatient mortality from traumatic spinal cord injury has increased over time, but there was a decrease in mortality over time for older patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Traumatic spinal cord injury poses a significant burden on the current healthcare system. Despite this, there is a dearth of literature about its trends, incidence, etiology and mortality. This information is vital as it can help target preventative efforts to at-risk populations, as well as contribute to information concerning the disabled population in the U.S.
This study aimed to investigate national trends of acute traumatic spinal cord injury in the United States from 1993 to 2012. Although the absolute number of cases of spinal cord injury increased over time, the incidence remained stable due to an increase in the population. The younger male population experienced a decrease in incidence rate, likely from law and safety initiatives. The older population experienced an increase in incidence rate, likely associated with falls, which were increasingly associated with injury in this age group over time. Acute hospital mortality increased over time although mortality decreased in patients 85 and older. The limitations of this study stem from the database used for analysis, which may underestimate the cases of spinal cord injury and does not have clinical outcome information. Additionally, errors in coding of spinal code injury cases and changes to the coding of falls may have affected data. Nevertheless, this study provides important information about the national incidence and mortality trends of acute traumatic spinal cord injury.
In-Depth [retrospective cohort]: This study used information from the Nationwide Inpatient Sample (NIS) database to identify 63,109 patients with acute traumatic spinal cord injury in 1993-2012. The incidence rate for cases remained stable with 53 cases (95% CI, 52-54 cases) per 1 million in 1993 to 54 cases (95% CI, 53-55 cases) per 1 million in 2012. The estimated total number of cases increased from 13,706 in 1993 to an estimated 16,965 cases in 2012. Incidence rates as a function of age and sex demonstrated a decreasing trend in cases among younger males and females from 1993 to 2012. The older population, however, experienced a significant increase in incidence. In regards to etiology, falls were more responsible for traumatic spinal cord injuries increasing from causing 19.3% (95% CI, 17.9%-20.7%) of cases in 1997 to 40.4% (95% CI, 38.7%-42.0%) of cases in 2012. Patients receiving a vena cava filter significantly increased from 4% (95% CI, 3.5%-4.2%) to 14.5% (95% CI, 13.9%-15.0%) as well as procedures, such as intervertebral disk excision and spinal canal decompression. Acute in-hospital mortality increased from 6.6% (95% CI, 6.1%-7.0%) to 7.5% (95%CI, 7.0%-8.0%) although mortality trends for patients 85 and older decreased over the time period.
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