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Objectives: This study was designed to examine trends in demographic and injury-related information of individuals with spinal cord injury (SCI) treated over a 55 year period in the VA Health Care System.
Clinical Relevance: The health care needs of this population are changing - requiring more and different health care than in the past. Understanding demographic and injury-related trends in the SCI population will help with health care planning, cost projections and allocation of resources. Health care workers need to become familiar with the changes in SCI characteristics in order to provide adequate care for this population.
Methods: Data were retrieved from the medical records of SCI patients treated at the VAPAHCS SCI Center. A total of 656 patient charts were reviewed with data from 646 of them used for this analysis. Efforts were made to retrieve information on all patients ever seen at the SCI Center, however data analysis was performed only on those patients currently alive. Data were analyzed in approximate ten year intervals by date of injury; 1942-1955, 1956-1965, 1966-1975, 1976-1985, and 1986-1997. Descriptive statistics were performed on demographic and injury-related characteristics, and changes over time were evaluated.
Results: The number of SCI patients increased by 10% per decade from 1965-1997. The average age at the time of injury doubled from the 1942-1956 cohort (23.3 years) to the most recent cohort (46.0 years). The average age of all surviving patients was 60 years old (range: 19-88 years). The vast majority of patients were male and Caucasian. The current population is represented by 48% quadriplegic and 52% paraplegic individuals. Prior to 1966, over 70% of SCI resulted in paraplegia. Over the next three decades, the proportion of quadriplegic injuries has doubled to where 60% of new injuries result in quadriplegia. The proportion of patients with SCI classified as Frankel/ASIA A (i.e., complete motor loss) decreased over time while the proportion of those classified as Frankel/ASIA D (i.e., motor function at least partially intact) more than doubled from 11% to 24%. The majority of spinal cord injuries were caused by motor vehicle accidents (45.5%); additional causes of SCI were falls (15.5%), gun shot wounds (9.6%), diving incidents (8.4%), surgery (6.7%), medical reasons (6.8%), and other (13%). Little change was noted with time in the cause of SCI except that surgery accounted for nearly no SCI before 1986 but a substantial proportion (15%) after that.
Conclusions: These results represent the current population treated at the SCI Center and illustrate the changes in demographic and injury-related characteristics over the past 55 years. There are more patients with SCI, increased age in those sustaining SCI, and more quadriplegic and incomplete injuries than previously. Surgery accounts for more cases of SCI currently which also contributes to the increased age at injury.
Acknowledgments: VA Rehabilitation R&D Merit Review Grant #A2014-RA.