Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Neurosurg Spine. 2010 Feb;12(2):131-40. doi: 10.3171/2009.9.SPINE0943.
In this study the author documents the epidemiology of spine and spinal cord injuries (SCIs) over 2 decades at the largest Level I adult trauma center in Canada. He describes the current state of spine injuries (SIs), their changing patterns over the years, and the relative distribution of different demographic factors in a defined group of trauma patients.
Data on all trauma patients admitted to Sunnybrook Health Sciences Centre between 1986 and 2006 were collected from the Sunnybrook Trauma Registry Database. Aggregate data on SIs and SCIs, including demographic information, etiology, severity of injuries (injury severity score [ISS]), and associated injuries, were recorded. The data were analyzed in a main category of spinal fracture and/or dislocation with or without SI and in two subgroups of patients with SIs, one encompassing all forms of SCIs and the other including only complete SCIs (CSCIs). Collected data were evaluated using univariate techniques to depict the trend of variables over the years. The number of deaths per year and the length of stay (LOS) were used as crude measures of outcome. Several multivariate analysis techniques, including Poisson regression, were used to model the frequency of death and LOS as functions of various trauma variables.
There were 12,192 trauma patients in the study period with 23.2% having SIs, 5.4% having SCIs, and 3% having CSCIs. The SCIs constituted 23.3% of all SIs. The respective characteristics of the SI, SCI, and CSCI groups were as follows: median age 36, 33, and 30 years; median LOS 18, 27, and 29 days; median ISS 29, 30, and 34; female sex ratio 34, 24, and 23%; and case fatality rate 16.7, 16.6, and 21%. Seventy-nine percent of patients had associated head injuries; conversely, 24% of patients with head injuries had SIs. The mean admission age of patients increased by approximately 10 years over the study period, from the early 30s to the early 40s. The relative incidence of SIs remained stable at approximately 23%, but the incidence of SCIs decreased approximately 40% over time to 4.5%. Motor vehicle accidents remained the principal etiology of trauma, although falling and violence became more frequent contributors of SIs. The average annual ISS remained stable over time, but the LOS was reduced by 50% in both the SI and SCI groups. Age, ISS, and SCIs were associated with a longer LOS. The case fatality rate remained relatively unchanged over time. Poisson analysis suggested that the presence of an SCI does not change the case fatality rate.
Data in this analysis will provide useful information to guide future studies on changing SI patterns, possible etiologies, and efficient resource allocation for the management of these diseases.
本研究作者记录了加拿大最大的一级成人创伤中心 20 多年来脊柱和脊髓损伤（SCI）的流行病学。他描述了目前的脊柱损伤（SI）状况、多年来的变化模式以及特定创伤患者群体中不同人口统计学因素的相对分布。
从 Sunnybrook 创伤登记数据库中收集了 1986 年至 2006 年期间所有入住 Sunnybrook 健康科学中心的创伤患者的数据。记录了 SI 和 SCI 的综合数据，包括人口统计学信息、病因、损伤严重程度（损伤严重程度评分 [ISS]）和相关损伤。使用单变量技术分析数据，以描绘多年来变量的趋势。每年的死亡人数和住院时间（LOS）用作结果的粗略衡量标准。使用多种多元分析技术，包括泊松回归，将死亡和 LOS 频率建模为各种创伤变量的函数。
在研究期间，有 12192 名创伤患者，其中 23.2%有 SI，5.4%有 SCI，3%有 CSCIs。SCI 占所有 SI 的 23.3%。SI、SCI 和 CSCI 组的各自特征如下：中位数年龄 36、33 和 30 岁；中位数 LOS 18、27 和 29 天；中位数 ISS 29、30 和 34；女性性别比 34、24 和 23%；病死率 16.7、16.6 和 21%。79%的患者有相关的头部损伤；相反，24%的头部损伤患者有 SI。研究期间，患者的平均入院年龄从 30 多岁增加到 40 多岁，增加了约 10 岁。SI 的相对发病率保持在 23%左右，但 SCI 的发病率随着时间的推移下降了约 40%，降至 4.5%。机动车事故仍然是创伤的主要病因，尽管跌倒和暴力成为 SI 的更常见病因。平均每年的 ISS 保持稳定，但 SI 和 SCI 组的 LOS 减少了 50%。年龄、ISS 和 SCI 与 LOS 延长有关。病死率随时间相对保持不变。泊松分析表明，SCI 的存在不会改变病死率。
本分析中的数据将为指导有关 SI 模式变化、可能病因以及管理这些疾病的有效资源分配的未来研究提供有用信息。
