Douglas J Brown, Robert Campbell, George Coetzee, Michael Fitzharris, Fazlul Hoque, Shinsuke Katoh, Olive Kobusingye, Jianan Li, Ruth Marshall, Chris Mikton, Peter New, Alana Officer, Avi Ohry, Ari Seirlis, Per Von Groote, Dajue Wang, Eric Weerts, Joy Wee, Gabi Zeilig
- Monash University Accident Research Centre
- Epidemiology and Preventive Medicine Alfred Hospital
Research output: Chapter in Book/Report/Conference proceeding › Chapter [Book] › Research › peer-review
| English |
| International Perspectives on Spinal Cord Injury |
| Jerome Bickenbach, Alana Officer, Tom Shakespeare, Per von Groote |
| Geneva Switzerland |
| World Health Organization |
| 3 |
| 43-64 |
| 22 |
| 9789240691865 |
| 9789241564663, 9789240691858 |
| Published - 2013 |
Keywords
- spinal cord injury
- SCI
- prevention
- injury
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Introduction: Traumatic spinal cord injury [TSCI] is a catastrophic event with a considerable health and economic burden on individuals and countries. This study was performed to update an earlier systematic review and meta-analysis of epidemiological properties of TSCI in developing countries published in 2013. Methods: Various search methods including online searching in database of EMBASE and PubMed, and hand searching were performed [2012 to May 2020]. The keywords “Spinal cord injury,” “epidemiology,” “incidence,” and “prevalence” were used. Based on the definition of developing countries by the International Monetary Fund, studies related to developing countries were included. Data selection was according to PRISMA guidelines. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. Results of meta-analysis were presented as pooled frequency, and forest, funnel, and drapery plots. Results: We identified 47 studies from 23 developing countries. The pooled incidence of TSCI in developing countries was 22.55/million/year [95% CI: 13.52; 37.62/million/year]. Males comprised 80.09% [95% CI: 78.29%; 81.83%] of TSCIs, and under 30 years patients were the most affected age group. Two leading etiologies of TSCIs were motor vehicle crashes [43.18% [95% CI: 37.80%; 48.63%]] and falls [34.24% [95% CI: 29.08%; 39.59%], respectively]. The difference among the frequency of complete injury [49.47% [95% CI: 43.11%; 55.84%]] and incomplete injury [50.53% [95% CI: 44.16%; 56.89%]] was insignificant. The difference among frequency of tetraplegia [46.25% [95% CI: 37.78%; 54.83%]] and paraplegia [53.75% [95% CI: 45.17%; 62.22%]] was not statistically significant. The most prevalent level of TSCI was cervical injury [43.42% [95% CI: 37.38%; 49.55%]]. Conclusion: In developing countries, TSCIs are more common in young adults and males. Motor vehicle crashes and falls are the main etiologies. Understanding epidemiological characteristics of TSCIs could lead to implant-appropriate cost-effective preventive strategies to decrease TSCI incidence and burden.
© 2022 S. Karger AG, Basel
Introduction
Rationale
Traumatic spinal cord injury [TSCI] is a catastrophic event with a high mortality rate and physical and emotional difficulties for patients [1-3]. It is defined as injuries to the spinal cord, nerve roots, osseous structures, and disco-ligamentous components [4]. TSCI can be due to motorcar crashes, falling, violence, and sports [2]. Besides, it can cause a tremendous burden on societies [5, 6]. TSCI can cause pain, paralysis, spasticity, sensation loss, urinary, and fecal incontinence and makes patients susceptible to pneumonia, septicemia, urinary tract infections, pressure ulcers, and cardiac dysfunctions [7, 8]. Disabilities caused by TSCI can be permanent and not fully treated with medical care offered to patients today; therefore, preventive solutions might be valuable [9]. The global incidence of traumatic spinal injury [TSI] is about 10.5 cases per 100,000 persons [4]. The incidence of TSI showed more significant numbers in countries with low and middle income [13.69 per 100,000 persons] compared to countries with high income [8.72 per 100,000 persons] [4]. Despite higher incidence rates in developing countries, we see that information registration in these countries is less accurate and unreliable that it becomes hard to assess the global burden of TSCI [4, 10, 11]. The genuine registered information in developed countries cannot be implemented in developing countries because of different epidemiological patterns and causations.
Objectives
Because of inadequate information access, it is crucial to gather all epidemiological data in developing countries to plan more effective preventive strategies. The study aimed to, through a systematic synthesis and meta-analysis by updating our previous study published in 2013 [12], ease the access and interpretation of epidemiological properties and etiologic features of TSCI in developing countries.
Methods
All stages and structures of this systematic review and meta-analysis study are based on the PRISMA 2020 statement [13]. We also utilized methodological guidelines attributed to observational epidemiological systematic reviews reporting cumulative incidence and prevalence [14].
Eligibility Criteria
Instead of using the traditional PICO approach, including population, intervention, comparator, and outcome as inclusion structure, we applied the CoCoPop model [condition, context, and population] because it is more relevant to questions about prevalence and incidence, as is mentioned by Munn et al. [14].
Condition
In this review, we excluded studies of nontraumatic or mixed spinal cord injury [SCI] if it was not possible to distinguish different SCI major etiology groups clearly. Furthermore, we did not consider the TSI as same as TSCI, and we excluded all TSI injuries without mentioning the cord injury. To keep the generalizability of the result, we excluded studies focusing on a specific etiology [e.g., road traffic injuries], specific injury level [e.g., thoracic injury], or specific target population [e.g., workers].
Context
National and subnational studies of developing countries that reported the frequency of different traumatic etiologies, severity, or level of injury with adequate details were included. We defined the developing countries using the International Monetary Fund 2021 update. All included countries remained in developing countries group during the defined search period [15].
Population
Pediatric-onset [