| Objective Epidemiology of spinal cord injury (SCI) was surveyed retrospectively from January2004to December2008in Tianjin residents. The epidemiological characteristics of SCI in Tianjin was analyzed by comparison with data from other countries, which would help in taking effective preventive measures to reduce the incidence and mortality of SCI. The influence of demographic and clinical factors to the acute care length of stay (ACLOS) was analyzed, which would help in reducing the hospitalization time and the hospitalization expenses of patients with SCI and distributing the social health care resources reasonably.Materials and Methods Based on the epidemiological literatures of spinal cord injury and the advices from experts, the retrospectively analyzed questionnaire of hospitalized patients in Tianjin was designed. This study included all SCI patients aged15years or older who were admitted to tertiary hospitals in Tianjin from2004to2008. Epidemiological characteristics, such as age, sex, marital status, occupation, time of injury, date of admission, causes of injury, level of injury (cervical, thoracic, lumbar or sacrum), extent of injury (complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia), America Spinal Injury Association impairment scale, associated injuries, location of hospitalization, surgery or not, date of discharge, the cause of death were included. After data collection, the strict verification was performed to rule out the incomplete questionnaires (20%or more) and all remaining data was entered into the computer.Results A total of869patients were collected, with an estimated annual incidence was23.7per million. The male/female ratio was5.63:1. Mean age of SCI was46.0±14.2years (men45.8±14.2years, women47.5±14.5years), with a range of16-90years. Fall (37.6%) was regarded as the leading causes of injury, followed by motor vehicle collision (34.1%). With age increasing, proportion of falls was higher and higher; while motor vehicle collision was the main cause in the young adults. The lesion level was cervical in71.5%, thoracic in13.3%and lumbar/sacral in15.2%. Cervical spinal cord injury mainly occurred in the aged and the main cause was fall while thoracolumbar spinal cord injury mainly caused by motor vehicle collision. The frequency of tetraplegia (71.5%) was higher than paraplegia (28.5%), and roughly four-fifth of tetraplegia cases were incomplete injury. According to the America spinal injury association (ASIA) impairment scale, the proportion of class A, B, C and D was25.2%,18.2%,14.7%,41.9%respectively. In all patients with spinal cord injury,62.8%accompanied with the associated injuries, including spinal fractures, head and facial injuries, fractures of the limbs and pelvis. During the hospitalization,20.8%of patients occurred with complications, including the complications of respiratory system and urinary and hyponatremia.55.4%of patients underwent surgeries and the hospital mortality was1.4%. All deaths were caused by cervical injuries and patients died of respiratory failure accounting for91.7%.842cases were selected to do the study on the ACLOS and the median was20days (Q=23), which showed the skewed distribution. Further statistical conclusion was as follow:gender was not an predictor for ACLOS; ACLOS became shorter with age gradually; patients injured by "low fall" were prone to hospitalize for a shorter time than that of "high fall","motor vehicle collision" and "struck by object" groups; acute hospitalization was significantly longer for complete injury; associate injury and complications could prolong ACLOS obviously; surgery, as an independent influencing factor, was related to longer ACLOS; furthermore, the ACLOS of patients in suburban hospitals was also significantly longer than that of patients in urban hospitals.Conclusion At present, there were few epidemiology surveys of SCI carried out in China. This study showed that the incidence of SCI was lower compared to the developed countries and the absolute number of SCI was more because of the larger population base. Compared with the most developing countries, age of patients with SCI was older. Male patients were more than females, and the main cause was fall with motor vehicle collision followed, which showed the similarities with the most developing countries. In all cases, the cervical injuries accounted for bigger proportion and the incomplete injuries were more than the complete ones. Compared with other countries, hospital mortality was lower. The targeted preventions and first aid measures should be taken according to the epidemiological characteristics and developmental trend of SCI. For the ACLOS, the length of stay in Tianjin was different from other countries. The ACLOS took on different characteristics. Statistical analysis demonstrated that etiology, severity of injury, associated injury, complications, surgery and geographic location of the hospitalization all affected ACLOS significantly. However, the effect of gender on ACLOS was a null hypothesis. So in order to shorten the ACLOS, it was significant to manage these risk factors correctly. |
PDF Full Text Request