Spinal Cord Injuries Sustained in Road Crashes Are Not on the Decrease in France: A Study Based on Epidemiological Trends

Abstract

Traumatic spinal cord injuries (SCI) are rare but extremely costly. In order to improve the modelling of inclusion criteria for studies of SCI it is necessary to determine what epidemiological trends affect SCI. Using the Rhone Registry, which contains all the casualties resulting from road crashes in the Rhône département of France and codes their injuries using the Abbreviated Injury Scale (AIS), we describe the epidemiological trends that affect spinal cord injury (SCI), major spinal trauma (MST) and severe injuries (AIS4+) to other body regions between two periods 1996-2001 and 2003-2008. Although there has been a marked decrease (35%) in the incidence of casualties after a road traffic crash, and reductions of 22% in the incidence of MST and 33% in that of severe injuries (AIS4+) (p<0.001), for SCI the incidence rate and number of casualties have remained surprisingly stable. In the second period, there was no change in the incidence of SCI resulting from road traffic crashes, nor in the associated fatality, mortality and survival rates. The incidence for car users was significantly lower in the second period. This contrasts with the incidences for motorcyclists and for the group including pedestrians and cyclists which were respectively 47% and 77% higher in the second period. The median age of the casualties, the age-adjusted incidence of SCI and the number of associated injuries were also higher in the second period. We have observed a marked reduction in the incidence of road trauma including the most severe injuries, but not SCI. The higher proportion of motorcyclists, the increase in the age of casualties and the greater presence of multiple injuries are new factors in the epidemiology of SCI after a road crash.

The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients

“…Previous studies have suggested that the rate of T-SCI due to falls is increasing over time. 9,10 This was not the case in our study, nor in previous Canadian studies, as MVA remains the leading cause of T-SCI when individuals of all ages are considered. [17][18][19][20] MVA and falls are consistently the top two causes of T-SCI 6,11,13 and this was demonstrated in our, and other Canadian, studies.…”

“…4 The worldwide estimated incidence of T-SCI varies from 10.4 to 83 cases per million, 6 variability being due to regional differences in motor vehicle use and legislation, developing vs. developed countries, 7 and trends over time. Developed nations (Iceland, 8 France, 9 USA, 10 South Korea, 11 Netherlands, Ireland, Portugal, Australia 12 ) have reported that the average age of T-SCI is increasing, as well as the rate of T-SCI due to simple falls. The mortality rate for individuals with T-SCI in developed nations is half the rate in developing nations.…”

Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis

“…Among those studies that investigated trends, all were in high-resourced countries, with extended periods of follow-up (between 12 and 51 years of follow-up) and a tradition of modern SCI management [9,10,19,52,54,55,57,77,110]. For example, Middleton et al found evidence of improvements in life expectancy and survival, especially among paraplegics, Saunders et al found an overall decrease in the TSCI mortality rate, while Hagen et al found no significant change in SMRs over time [9,10,52].…”

Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland

“…This can likely be attributed in part to changes of the physical and social environment at the level of the pre-event phase such as the introduction of speed limits on roads and reassessment of driving ability at older ages. Further, seatbelt requirements related to seatbelt use ( host/person ), presence of seatbelts ( vehicle ), and laws mandating seatbelt use ( social and physical environment ) have reduced the incidence of road traffic injuries in Switzerland and globally at the event phase (FEDRO 2014 ; WHO 2004 ; Lieutaud et al 2012 ). However, the relatively large proportion of transport-related TSCIs, specifically due to car and motorcycle crashes, suggest further scope for prevention efforts.…”