10 Feb Falls Main Cause of Adult Traumatic Spinal Cord Injuries

MedicalResearch.com Interview with study leaders:
Shalini Selvarajah MD, MPH
Postdoctoral Research Fellow
Center for Surgical Trials and Outcomes Research
Department of Surgery
Johns Hopkins University School of Medicine
Baltimore, MD 21287  and

Edward R. Hammond, MD, PhD, MPH
Research Associate
International Center for Spinal Cord Injury
Hugo W. Moser Research Institute at Kennedy Krieger Institute
Baltimore, MD 21205.

MedicalResearch.com: What are the main findings of the study?

Researchers:

·    Between 2007 and 2010, the number of serious traumatic spinal cord injuries (TSCI) in the United States (U.S.) increased, doing so more rapidly among older adults (age ≥65 years) compared to younger adults (age <65 years). Injuries from falls have overtaken motor vehicle crashes as the main cause of adult TSCI.

·    Older adults are more likely to experience worse outcomes compared to younger adults even after taking into account severity and mechanism of injury, as well as other co-morbid conditions. Older adults are 4 times more likely to die in the emergency room, and if admitted to inpatient care, they are 6 times more likely to die as inpatients compared to younger adults.

·    Emergency room charges for treatment of acute TSCI among adults increased 20% from $3,342 per encounter in 2007 to $4,024 per encounter in 2010 even after accounting for the cost of inflation.

MedicalResearch.com: Were any of the findings unexpected?

Researchers: Our research is the first to utilize the National Emergency Department Sample (NEDS), the largest all-payer emergency department database in the U.S., which utilizes emergency room billing data in a manner that allows representative U.S. population estimates to be determined. Prior to our work, the last reported national estimate of the burden of TSCI was in 1981. Since then, the National Spinal Cord Injury Statistical Center has estimated national incidence rates using a combination of regional or facility-based research conducted in the 1980s and 1990s. These estimates suggest an overall increase in incidence of TSCI.

Our findings suggest that the average age at injury is 50 years, an increase from 29 years reported in 1981. Because older adults and younger adults may have different causes of TSCI, we evaluated these groups separately and determined that the incidence of TSCI was actually increasing only among older adults and driven mainly by falls. The incidence among younger adults stayed fairly stable throughout the study period.

MedicalResearch.com: What should clinicians and patients take away from your report?

Researchers: In the context of an aging U.S. population, our findings reinforce the need to prevent injury from falls and trips, which can result in TSCI, especially among older adults. Preventative efforts will reduce the potential lifelong disability and increasing financial burden of TSCI.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Researchers: There is a need to consider injury prevention programs tailored for specific age groups. Future research examining risk factors associated with the occurrence of injury, and poorer outcomes observed among older adults is necessary. An in-depth assessment of clinical data at the emergency room as well as during the initial inpatient stay may reveal useful information that could inform injury prevention and policy.

Citation:

The Burden of Acute Traumatic Spinal Cord Injury among Adults in the United States: An Update

J Neurotrauma. 2014 Feb 1;31(3):228-38. doi: 10.1089/neu.2013.3098
Epub 2014 Jan 9.
Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, Hyder O, Gupta D, Black JH 3rd, Schneider EB.

Last Updated on April 19, 2014 by Marie Benz MD FAAD