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COMMENTARY
Year : 2014  |  Volume : 140  |  Issue : 1  |  Page : 5-7

How to prevent early mortality due to spinal cord injuries? New evidence & update


Spinal Cord Injury Centre of Western Denmark Department of Neurology, Regional Hospital of Viborg, Soendersoeparken 21 8800, Viborg, Denmark; Department of Clinical Medicine University of Bergen, Bergen, Norway; Department of Clinical Medicine Aarhus University, Aarhus, Denmark

Date of Web Publication4-Sep-2014

Correspondence Address:
Ellen Merete Hagen
Spinal Cord Injury Centre of Western Denmark Department of Neurology, Regional Hospital of Viborg, Soendersoeparken 21 8800, Viborg, Denmark; Department of Clinical Medicine University of Bergen, Bergen, Norway; Department of Clinical Medicine Aarhus University, Aarhus, Denmark

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Source of Support: None, Conflict of Interest: None


PMID: 25228084

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How to cite this article:
Hagen EM. How to prevent early mortality due to spinal cord injuries? New evidence & update. Indian J Med Res 2014;140:5-7

How to cite this URL:
Hagen EM. How to prevent early mortality due to spinal cord injuries? New evidence & update. Indian J Med Res [serial online] 2014 [cited 2019 Nov 21];140:5-7. Available from: http://www.ijmr.org.in/text.asp?2014/140/1/5/139955

According to the most recent report by the World Health Organization, between 250,000 and 500,000 people suffer from a traumatic spinal cord injury (SCI) every year [1] . The leading causes are road traffic accidents, falls and violence [1] . In this issue, Lalwani et al[2] describe the mortality profile of patients with spinal cord injuries in New Delhi, in order to identify factors predictive of an increased mortality risk. This knowledge will improve patient care, guide injury prevention activities, target staff education programmes, as well as directing research efforts. They studied computerized patient records and autopsy reports from the department of Forensic Medicine at a level I trauma care centre in New Delhi, India, and identified 341 patients with traumatic SCI who died between January 2008 and December 2011.

There are large variations in the published studies worldwide on traumatic SCI with regard to incidence, prevalence, gender distribution, mechanism of injury, level of injury, and completeness of injury [3] . Most follow up studies of traumatic SCI are from rehabilitation centres that receive patients many months after the time of injury. Many studies, therefore, choose to exclude all those who die within one year after their injury, and define one year after injury, as the distinction between early and late death [3] . Only a few studies include pre-hospital deaths [4],[5],[6] .


   Epidemiology of traumatic spinal cord injuries in India Top


Lalwani et al[2] identified 84.5 per cent males and 15.6 per cent females. Most deceased (73%) were in the age group 25-64 yr, followed by young adults between 16 and 24 yr (19.4%). The level of injury was cervical in 76 per cent, thoracic in 16.4 per cent and thoraco-lumbar in 7.6 per cent of the deceased. The most common cause of injury was high energy falls 44.3 per cent, followed by road traffic accidents 41.9 per cent.

The published research on epidemiology of traumatic SCI in India is very limited. Chacko et al[7] reported 125 patients with SCI admitted to a rural hospital in India during the previous seven years. In this population, 92.6 per cent were men and 7.4 per cent women, and 60.5 per cent were in the 3 rd and 4 th decades. Fifty five per cent were admitted within

24 h after injury. Cervical spine injuries comprised 8.6 per cent whereas thoracic and lumbar spine comprised 32.3 and 59.1 per cent respectively [7] .

Singh et al[8] reported 483 traumatic SCI in Haryana during 2000-2001. The average age at time of injury was 35.4 yr and 74.4 per cent were men. Fall from height was the most frequent cause of trauma (44.5%), followed by motor vehicle accidents (34.7%). Among the 447 patients with neurological deficits, 36.7 per cent were tetraplegics and 63.3 per cent paraplegics. The most common levels of injury were first lumbar and fifth cervical vertebra [8] .

Agarwal et al[9] identified 107 patients with a traumatic SCI in a retrospective descriptive analysis of data of patients with SCI admitted to a tertiary medical centre during 2003-2004. Of these, 50.5 per cent had a cervical injury, 24.3 per cent thoracic and 25.2 per cent lumbar injury, and 83.4 per cent were men. Fall from height was the major cause of injury (59.3%), followed by motor vehicle accidents (21.2%) and fall of weight (10.2%). Motor vehicle accidents were more common in men and fall of weight in women [9] .

Pandey et al[10] . identified 60 patients with traumatic SCI admitted for rehabilitation between August 2005 and May 2006. Of these, 85 per cent were men, the mean age was 34 yr, and 48.3 per cent were due to fall from height.

The data from the study by Lalwani et al[2] are comparable to the published studies with regard to gender and age distribution. Level of injury was also similar among the studies. Of the deceased in the present study, most had a cervical injury, comparable to only a few of the surviving patients in the previous published studies had a cervical injury. Falling from a height is the most common cause of injury in India. However, it seems that high energy falls often result in a cervical injury and death, while falling from a low height results in surviving patients with more diverse injuries. In the study by Lalwani et al[2] the percentages of patients who died from a motor vehicle accident was higher than previous reports. This could be due to the fact that the study was performed in the capital city of India.


   Knowledge of pre-hospital deaths of traumatic spinal cord injuries worldwide Top


Lalwani et al[2] identified the majority of deaths (51.6%) to occur during phase IV (secondary to tertiary complications of trauma i.e. >1 wk); 40 patients (11.7%) died during phase I (brought dead on-arrival or surviving <3 h), 55 (16.1%) during phase II (>3 h to 24 h) and 70 (20.5%) during phase III (> 24 h to 7 days). Among the 95 patients (27.9%) who survived less than 24 h, 86.3 per cent had associated injury while only 28.5 per cent of patients who survived more than 24 h sustained associated injuries [2] .

There are only a few studies on the relationship between time of death after a traumatic SCI, level of injury and cause of injury.

Kraus et al[6] identified 619 patients with traumatic SCI in a study from North California between 1970 and 1971, among these were 299 deaths. Almost 79 per cent of the persons were dead on-arrival at the hospital emergency room or taken directly to the county morgue (38.0% of the total population). Sixty four (21.4 %, or 10.3% of the total population) died during hospitalization [6] .

Martins et al[4] studied traumatic SCI in Portugal during the period 1989-1992. They identified 398 new traumatic SCI, of which, 77 per cent were male and 23 per cent female. The average age was 50.5 yr. Sixty four (16%) were dead upon arrival at hospital, and 159 (40%) died during hospitalization. The death rate was high during the first week, especially during the first 24 h [4] .

Surkin et al[11] identified 395 patients with traumatic SCI in Mississippi from 1992-1994. Among these patients, 40.7 per cent were dead by the end of the study period. Among those who died, 56.5 per cent (23% of the 395 patients) died before reaching a hospital [11] .

Dryden et al[5] identified 450 cases of traumatic SCI in Canada during 1997-2000. Of these, 15.8 per cent died prior to hospitalization. The percentages of patients with traumatic SCI brought dead to hospitals in published studies are 11-38 per cent.

The number of deaths due to road traffic accidents in India has increased during the last 10 years according to the Ministry of Road Transport and Highways, Transport Research Wing, Government of India [12] . These numbers call for increased surveillance and prevention measurements regarding road traffic accidents in India. However, as Lalwani et al[2] found, the 86.3 per cent of the patients who survived less than 24 h had associated injuries, while only 28.5 per cent of patients who survived more than 24 h had associated injuries. The outcome after a trauma depends not only on the injury, but also on the victim's health condition at the time of injury, associated injuries and the energy of trauma [13] .

This study adds new knowledge to mortality and survival after traumatic SCI. Whether this is a common finding worldwide is yet to be confirmed by similar studies.

 
   References Top

1.World Health Organization. International Perspectives on Spinal Cord Injury. Malta: © World Health Organization; 2013. Available from : http://www.who.int/disabilities/policies/spinal_cord_injury/en/, accessed on July 15, 2014.  Back to cited text no. 1
    
2.Lalwani S, Singh V, Trikha V, Sharma V, Kumar S, Bagla R, et al. Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India. Indian J Med Res 2014; 140 : 40-5.  Back to cited text no. 2
    
3.Hagen EM, Rekand T, Gilhus NE, Gronning M. Traumatic spinal cord injuries - incidence, mechanisms and course. Tidsskr Nor Laegeforen 2012; 132 : 831-7.  Back to cited text no. 3
    
4.Martins F, Freitas F, Martins L, Dartigues JF, Barat M. Spinal cord injuries--epidemiology in Portugal's central region. Spinal Cord 1998; 36 : 574-8.  Back to cited text no. 4
    
5.Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, et al. The epidemiology of traumatic spinal cord injury in Alberta, Canada. Can J Neurol Sci 2003; 30 : 113-21.  Back to cited text no. 5
    
6.Kraus JF, Franti CE, Riggins RS, Richards D, Borhani NO. Incidence of traumatic spinal cord lesions. J Chronic Dis 1975; 28 : 471-92.  Back to cited text no. 6
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7.Chacko V, Joseph B, Mohanty SP, Jacob T. Management of spinal cord injury in a general hospital in rural India. Paraplegia 1986; 24 : 330-5.  Back to cited text no. 7
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8.Singh R, Sharma SC, Mittal R, Sharma A. Traumatic spinal cord injuries in Haryana: An epidemiological study. Indian J Community Med 2003; 28 : 184-6.  Back to cited text no. 8
    
9.Agarwal P, Upadhyay P, Raja K. A demographic profile of traumatic and non-traumatic spinal injury cases: a hospital-based study from India. Spinal Cord 2007; 45 : 597-602.  Back to cited text no. 9
    
10.Pandey V, Nigam V, Goyal T, Chhabra H. Care of post-traumatic spinal cord injury patients in India: an analysis. Indian J Orthop 2007; 41 : 295-9.  Back to cited text no. 10
    
11.Surkin J, Gilbert BJ, Harkey HL 3 rd , Sniezek J, Currier M. Spinal cord injury in Mississippi. Findings and evaluation, 1992-1994. Spine 2000; 25 : 716-21.  Back to cited text no. 11
    
12.Ministry of Road Transport and Highways, Transport Research Wing, Government of India. Road accidents in India 2012. New Delhi : Ministry of Road Transport and Highways, Transport Research Wing, Government of India; 2013.   Back to cited text no. 12
    
13.Staff T, Eken T, Wik L, Røislien J, Søvik S. Physiologic, demographic and mechanistic factors predicting New Injury Severity Score (NISS) in motor vehicle accident victims. Injury 2014; 45 : 9-15.  Back to cited text no. 13
    




 

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