Current Trends Trends in Traumatic Spinal Cord Injury -- New York, 1982 - 1988

In the United States, injuries resulting from falls are the most common type of injury among persons greater than or equal to 65 years of age (1), and most spinal cord injuries (SCIs) among persons in this age group are caused by falls (2). SCI, with its resultant paralysis, is one of the most catastrophic and devastating medical conditions. Previous studies have characterized the epidemiology of SCI (2-4). This report describes changes in the reported incidence of SCI in New York during 1982-1988.

Data on SCIs were obtained from the New York State Department of Health's Statewide Planning and Research Cooperative System, which documents all hospital discharges from acute-care facilities in New York. This study included a review of hospital discharges from 1982 (the first year information distinguishing new admissions from transfer patients became available) through 1988 (the most recent year for which data are available). Transfer patients were eliminated to avoid duplicate counts of the same person. SCI patients included in the study were New York residents with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) principal diagnosis codes (N-codes) 806 (fracture of vertebral column with SCI) or 952 (SCI without evidence of spinal bone injury). In addition, patients were included if a secondary diagnosis indicated SCI and the principal diagnosis indicated any form of traumatic injury, defined as ICD-9-CM rubrics 800-959, excluding 905-909 (late effects), 930-939 (foreign bodies), and 958 (early complications) (5). Incidence rates were calculated by year, sex, and age group. Heterogeneity in annual rates was tested using a chi-square statistic (6).

During 1982-1988, 5384 traumatic SCI discharges were reported, for an average crude annual rate of 4.3 SCIs per 100,000 residents. This rate is within the range reported in previous studies (2.8-5.3 SCIs per 100,000 persons) (2-4), although it is somewhat higher than the average annual U.S. estimate (3.1 per 100,000) (2).

Annual SCI rates did not change significantly over time for men or for all persons (Figure 1). However, a significant (p less than 0.001) decrease occurred in rates for women over time (Figure 2); the largest decrease was for women greater than or equal to 65 years of age. For men, rates did not decrease for any age group.

Although data are not available for 1982-1988 on the cause of injury for hospital discharges, data are available on the cause of injury deaths. Preliminary analysis of all deaths from falls among persons aged greater than or equal to 65 years during 1982-1988 showed a continual decline in rates for women over time, from 29 deaths per 100,000 women in 1982 to 24 per 100,000 in 1988. Rates for men declined from 40 deaths per 100,000 men in 1982 to 28 per 100,000 in 1984, then fluctuated from 1985 through 1988 (range: 29 per 100,000 in 1987 to 33 per 100,000 in 1988). Reported by: JH Relethford, PhD, SJ Standfast, MD, DL Morse, MD, State Epidemiologist, New York State Dept of Health. Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Interpretation of the trends reported here illustrate how attempts to study severe, nonfatal injuries are frequently complicated by inadequate data. External cause of injury codes (E-codes) were not required in New York hospital discharge records until 1990; their inclusion will allow more detailed analyses of trends in future years. Many scientific and professional groups and private organizations have recognized the need for E-coding hospital discharge data. Both the Association of State and Territorial Health Officials and the Council of State and Territorial Epidemiologists have recommended that hospital discharge data be E-coded. Two reports from the National Research Council have described the detrimental effects on injury research caused by the lack of these data and recommended that hospital discharge data be E-coded (7,8). Six states (Arizona, California, New York, Rhode Island, Vermont, and Washington), whose combined populations total more than 20% of the nation's population, have recently begun requiring the use of E-codes in their hospital discharge data. The universal adoption of E-codes on hospital discharges will provide the most cost-effective mechanism for obtaining injury morbidity and cost data.

Universal adoption of E-coding presents logistic and technical challenges. However, E-coding coupled with mandatory reporting of SCIs will permit researchers and health department officials to determine the incidence of SCI, identify high-risk groups, define etiologies, and evaluate the effectiveness of intervention measures. In addition, the Institute of Medicine\'s Committee on a National Agenda for the Prevention of Disabilities recently recommended the development of a national disability surveillance system to monitor the incidence and prevalence of 1) functional limitations and disabilities; 2) specific developmental disabilities, injuries, and diseases that cause functional limitations and disability; and 3) secondary conditions resulting from the primary disability. Information derived from E-coding is a fundamental requisite for such a system.

References

1. Rice DP, MacKenzie EJ, Jones AS, et al. The cost of injury in the United States: a report to Congress. San Francisco: University of California, Institute of Health and Aging; Johns Hopkins University, Injury Prevention Center, 1989.

2. Stover SL, Fine PR, eds. Spinal cord injury: the facts and figures. Birmingham, Alabama: University of Alabama at Birmingham, 1986.

3. DeVivo MJ, Fine PR, Maetz HM, Stover SL. Prevalence of spinal cord injury: a re-estimation employing life table techniques. Arch Neurol 1980;37:707-8.

4. Kraus JF. Epidemiologic aspects of acute spinal cord injury: a review of incidence, prevalence, causes and outcomes. In: Becker DP, Povlishock JT, eds. Central nervous system trauma status report. Bethesda, Maryland: National Institutes of Health, National Institute of Neurological and Communicative Disorders and Stroke, 1985:313-22.

5. Marganitt B, MacKenzie EJ, Smith GS, Damiano AM. Coding external causes of injury (E-codes) in Maryland hospital discharges 1979-88: a statewide study to explore the uncoded population. Am J Public Health 1990;80:1463-6.

6. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley and Sons, 1981.

7. National Research Council/Institute of Medicine, Committee on Trauma Research. Injury in America. Washington, DC: National Academy Press, 1985.

8. Committee to Review the Status and Progress of the Injury Control Program at the Centers for Disease Control. Injury control. Washington, DC: National Academy Press, 1988.

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