Epidemiology of spinal cord injury (SCI) Ireland-Why this subject?

Epidemiology describes the causes of injury (or any health condition), who it affects and the types of injury that occur. The previous study  examined the number of cases of traumatic SCI, admitted to the National Rehabilitation Hospital in 2000. That year, there were 46 cases or 13 per million population, half of which were due to road crashes; average age of injury was around 37 years. It has been the opinion of health-care professionals working in SCI that the epidemiology has changed in recent years, so an extensive review of this topic was carried out during 2016 and 2017.

Two studies, one retrospective and one prospective were done on traumatic SCI and one on non-traumatic SCI. SCI in children was also reviewed.

Between 2010 and 2016, the number of new cases of traumatic SCI was quite consistent, from a lowest number of 53 in 2014 to a high of 61 in 2013 and again in 2016; per million population, this equated to a range between 11.5 and 12.8, one of the lowest incidences in the developed world. Non-traumatic SCI has never been studied in Ireland previously.

Males remain in the majority, 72.1% of injured persons. There are more older people sustaining traumatic SCI and as a result, the mean age at onset is steadily rising as is evident from the table below.

Average age and age ranges of traumatic spinal cord injury onset

 

2010

 

2011

 

2012

 

2013

 

2014

 

2015

 

2016

Average age

(Years)

 

44.1

 

49.3

 

48.3

 

47.9

 

52.6

 

51.2

 

52.8

Age range

(years)

 

18 – 87

 

16 – 89

 

19 – 81

 

16 – 85

 

17 – 89

 

17 – 89

 

17 – 98

During 2017, there were 128 new cases, which is an incidence per million population of 26.7, more than double that of traumatic SCI in any year. The number of older people who develop non-traumatic SCI is even greater than that of traumatic SCI, resulting in a higher average age of onset – this was 56.7 years with an age range of 17 to 87 years. The gender split is fairly equal, 50.8% of cases were female. Incomplete paraplegia was the most common pattern of injury, partial but not total paralysis of the lower limbs only, sometimes accompanied by bladder & bowel difficulties.

Degenerate conditions of the spine were the most common cause (almost half) – an example might be a disc prolapse or arthritic changes in the vertebrae compressing the spinal cord. Tumours were the 2ndmost common cause (26%), most of which were metastatic spinal cord compression or secondaries from cancer

Finally, spinal cord injury in children is exceedingly rare. Between 2000 and 2015, the incidence per million population was 1.4 per million per year for traumatic SCI and 1.6 per million per year for non-traumatic SCI. This means that 1 or perhaps 2 children have a traumatic SCI and the same number, a non-traumatic SCI in Ireland each year. Road crashes were the most common cause of traumatic SCI and  traumatic cause. Thankfully, the majority of the injuries in children did not affect the upper limbs and the children with non-traumatic SCI, in particular, had a lot of recovery in the lower limbs.

What this research means and what will Spinal Injuries Ireland need to consider?

There are many implications of these research findings in the adult population for Spinal Injuries Ireland. Higher numbers of people with newly acquired SCI means  greater demand for the service provided by SII.

With an older age profile, there is a need to provide peer support for this age group and possibly less demand on vocational and sports/leisure services. Some frail older people, or those with SCI due to cancer secondaries, might not be fit for an active rehabilitation programme in the NRH or may have a shorter life expectancy and opt to return closer to their families as soon as possible after the acute phase of care. This could pose difficulties for SII, trying to bridge the gap to patients who have not had specialist rehabilitation at the NRH, and therefore might not have been educated to a high level on issues such as bowel, skin and bladder care, and have had less exposure to appropriate equipment such as wheelchairs and assistive technology.

In addition, it can be more difficult for an older person to achieve home discharge after a severe injury particularly if he/she lives alone. In this case, SII may have to play a bigger role in advocating for larger home care packages for older people or alternatively, might have to provide support and advocacy for older people as they settle into a new life in a nursing home.

 

 

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