The epidemiology and economics of spinal cord injury

Abstract

Incidence and prevalenceThe incidence of spinal cord injury (SCI) varies according to source, however, reports considered to be most accurate indicate that the annual rate is between 30·0 and 32·1 new spinal cord injuries per million persons at risk in the U.S.A. (DeVivo et al., 1980; Kraus et al., 1975). DeVivo, et al. (1980), used the mathematical relationship between incidence and duration to re-estimate the prevalence of SCI, calculating the rate to be approximately 906 per million.This figure is nearly 50° () greater than that estimated by Kurtzke (1975) who based his calculations on the length of median post-injury survival; a less precise statistic in light of that which is known today. Age, sex and raceIn the U.S.A., SCIs occur most frequently in persons between 15 and 20 years of age. According to the National SCI Database maintained by the Department of Rehabilitation Medicine at the University of Alabama at Birmingham, the mean age at injury is 29·7 years, the median age is 25 years and the mode (i.e. the most frequent age at injury) is 19 years (Stover and Fine, 1986). Reported differences in age distribution are believed to reflect a myriad of non-comparable data collection strategies. The National SCI Database confirms that SCI occurs more frequently among males than among females (a 4: 1 ratio) and that the average, annual race-specific incidence rates for SCI are slightly higher for blacks than whites, a finding consistent with the higher accidental death rate observed among blacks (Accident Facts, 1983). EtiologyA review of the 10 000 + cases documented in the National SCI database con firms that in the U.S.A., as in virtually all other industrialised countries, most spinal cord injuries result from motor vehicle crashes (47·7%) followed by falls (20·8° 0)' acts of violence-gunshot wounds and stabbings (14·6%) and sporting-

Epidemiology of spinal cord lesions in Denmark

“…Our overall male/female ratio of 3·3 is low in comparison to most previous studies (Kurtzke, 1975;Shanmugasundaram, 1987;Stover and Fine, 1987;Wig glesworth, 1987), but a little higher than others (Bracken et ai., 1981;Forner et ai., 1983;Kraus et ai., 1975;Kuhn et ai., 1983). As pointed out by Kuhn et ai.…”

“…The number of tetraplegics equalled that of paraplegics (including conus cauda equina lesions), which was also found by others (Chen and Lien, 1985;Kraus et al, 1975;Kurtzke, 1975;Stover and Fine, 1987), unlike some series where two-limb involvement was twice as frequent as four (Gehrig and Michaelis, 1968;Kurtzke, 1975).…”

“…This is similar to the frequency in other countries (Burke, 1977;Frankel et at., 1969;Girard et at., 1980;Griffiths, 1980;Kurtzke, 1975;Ohry and Rozin, 1982;Steinbriick and Paeslack, 1980;Stover and Fine, 1987), and as in most other series diving into shallow water was the commonest cause. The danger of severe injuries associated with the use of trampoline has previously been stressed (Ellis et at., 1960;Krawitz, 1978;Stein briick and Paeslack, 1978), and in Denmark this knowledge resulted in 1981 in the ban on usage of trampolines in schools.…”

“…The age distribution of the traumatic SCI in the present material is similar to previous studies (Bracken et ai., 1981;Burke and Toscano, 1987;Fine et ai., 1979Fine et ai., -1980Gjone andNordlie, 1978-1979;Kurtzke, 1975;Minaire et ai., 1978Minaire et ai., -1979Stover and Fine, 1987;Wigglesworth, 1987) with the young dominat ing in contrast to the non-traumatic spinal cord lesions, where 50-59 year olds were in excess.…”

Effects of repeated ejaculations on semen characteristics following spinal cord injury

“…2,3 About 70% of SCI patients are under 40 years of age and 80-85% are men. [4][5][6] Infertility is a recognised problem in men following SCI. Historically, Bors and Comarr 7 reported an ejaculation rate of only 5% for men with complete upper motor neurone lesions that increased to 32% if the lesion was incomplete.…”