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Spinal cord injury etiology, severity, and care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objectives

To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries.

Setting

SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand.

Methods

Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression.

Results

Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence.

Conclusions

Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This study was funded by the Mayo Clinic Global Health Program.

Author information

Authors and Affiliations

  1. Mayo Clinic, Rochester, MN, USA

    Benjamin D. Holmes

  2. Medical College of Wisconsin, Milwaukee, WI, USA

    Ruta Brazauskas

  3. Sri Balaji Action Medical Institute, New Delhi, India

    Harvinder S. Chhabra

Authors
  1. Benjamin D. Holmes
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  2. Ruta Brazauskas
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  3. Harvinder S. Chhabra
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Contributions

BDH conceived of and designed the project, interpreted results, and drafted and revised the manuscript. RB provided statistical analysis and result interpretation, and drafted and revised the manuscript. HSC assisted in project conception and design, acquired data, and revised the manuscript.

Corresponding author

Correspondence to Benjamin D. Holmes.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

Ethics approval was provided for this project by both the Mayo Clinic Institutional Review Board and the International Spinal Cord Society Database Project Scientific Committee. The need for informed consent was waived.

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Holmes, B.D., Brazauskas, R. & Chhabra, H.S. Spinal cord injury etiology, severity, and care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-01003-7

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  • DOI: https://doi.org/10.1038/s41393-024-01003-7

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