Spinal cord injuries sustained in road crashes are not on the decrease in france: a study based on epidemiological trends

Evaluation of safety and performance of the self balancing walking system Atalante in patients with complete motor spinal cord injury

STUDY DESIGN

Prospective, open label, observational.

OBJECTIVES

To present results of the first clinical study on a newly developed robotic exoskeleton (Atalante®, Wandercraft, Paris, France) that enables individuals with spinal cord injury (SCI) to perform ambulatory functions without technical aids.

SETTING

Two sites specialized in SCI rehabilitation, France.

METHODS

Inclusion criteria were presence of chronic complete SCI (AIS A) ranging from T5 to T12. The study protocol included 12 one-hour training sessions during 3 weeks. Patients walked on floor with robotic assistance and wore a harness connected to a mobile suspension system (without weight-bearing) to prevent from falling. Main outcome was the ability to walk 10 meters unassisted, secondary outcomes were assessment of other ambulatory functions, bladder and bowel functions, pain and spasticity.

RESULTS

Twelve patients were enrolled, and 11 completed the protocol, mean age 33,9 years. Six patients had T6 levels of lesion or above. Seven patients passed the 10mWT at the 12th session unassisted (mean walking speed 0.13 m/s) while four required some human help. All patients succeeded at the other ambulatory tests (stand-up, sit-down, balance, turn). There were no significant change for bladder (Qualiveen) or bowel (NBD) functions, neuropathic pain (NPSI, NPRS), yet five patients reported a subjective improvement of their bowel function. Impact on spasticity was variable depending on the muscle examined (Ashworth). Ischial skin erosion was seen in one patient that needed local dressing.

CONCLUSION

The Atalante system is safe and enables to perform ambulatory functions in patients with complete SCI.

Prospective multicentre observational study assessing the tolerance and perception of patients using the Liquick Base catheter with an Ergothan tip

INTRODUCTION

Intermittent self-catheterisation has revolutionised the management of neurogenic bladder-sphincter dysfunctions. The Liquick Base catheter is characterised by a streamlined Ergothan tip. The purpose of this study is to assess the tolerance and perception of patients using this catheter.

MATERIALS AND METHODS

A French prospective multicentre observational study was conducted on patients with neurogenic bladder-sphincter dysfunctions. Upon inclusion in the study, the doctor completed a questionnaire on the patient's pathology. After 3 and 6 months, the doctor checked for neurogenic developments or observations and looked for any complications relating to intermittent self-catheterisation. The patient completed a questionnaire to assess his or her perception of using the catheter.

RESULTS

Out of 42 patients included in the study, two were excluded. Out of the 40 assessed patients (30 males, 10 females) with an average age of 50.1±14.9 years, there were no reported cases of false passage. Bleeding occurred at least once in 10 patients (25%) in the first three months and in three out of 20 patients (15%) between 3 and 6 months. Two (5%) patients sought medical attention in the first three months for complications related to the catheter and 4 patients sought medical attention (10%) between 3 and 6 months. After 3 months 90% of patients were still using the catheter and after 6 months 90% of patients were still using the catheter.

CONCLUSION

The Liquick Base catheter is well tolerated. Patient perception is positive for all parameters being examined, leading to the continued use of the catheter in 90% of cases.

LEVEL OF EVIDENCE

2.

Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities

BACKGROUND

Although several investigations have examined the epidemiology of cervical spine injuries in sports, few studies have analyzed the nationwide incidence and sex-specific epidemiology of cervical spine injuries.

METHOD

The National Electronic Injury Surveillance System database, which collects information on patients presenting to the emergency department at 100 hospitals across the United States, was queried for neck sprains and cervical fractures associated with sporting activities from 2000-2015.

RESULT

A total of 26,380 neck sprains and 1166 fractures were identified. Compared with females, the incidence for injuries in males was 1.7 times greater for neck sprains and 3.6 times greater for fractures (P < 0.0001). Football was the most common cause of cervical sprains in males, followed by cycling and weightlifting/aerobics. Females sustained most neck sprains in weightlifting/aerobics, trampoline, and cheerleading. From 2000 to 2015, the incidence of neck sprains from aerobics increased from 15.5 to 25.3 per million person-years (P < 0.0001). Similarly, the incidence of cervical fractures from cycling increased from 0.67 to 2.7 per million (P < 0.0001). For males, cycling was the most common cause of fracture, followed by diving/swimming and football. For females, horseback riding was most common, followed by cycling and diving/swimming.

CONCLUSIONS

Football is the leading cause of cervical sprains in the United States. The most common cause of cervical fracture in men is cycling, while in women it is horseback riding. The incidence of sport-related cervical fractures has increased by 35% from 2000 to 2015, which has been driven by an increase in cycling-related injuries.

National analysis of testicular and scrotal trauma in the USA

Background

To provide a descriptive analysis of scrotal and testicular trauma in the USA. Additionally, we hypothesized that motorcycle collision would have a higher association with scrotal or testicular trauma and subsequent scrotal or testicular operation, compared to a bicycle collision.

Methods

The National Trauma Data Bank (2007–2015) was queried to identify adult male patients with scrotal or testicular trauma. A multivariable logistic regression analysis was performed.

Results

A total of 8,030 patients (0.23%) had scrotal/testicular injury, with 44.6% involved in blunt trauma. A penetrating mechanism occurred in 50.5% of cases, with assault by firearm (75.8%) being the most common. The median age of the patients was 31 years and the median injury severity score was 8. Most had isolated scrotal or testicular trauma (74.5%), with 48.3% requiring scrotal or testicular operation, most commonly repair of laceration (37.3%). Patients involved in a motorcycle collision had higher risk for scrotal/testicular trauma (OR=5.40, CI=4.40–6.61, p=0.0004) and subsequent scrotal/testicular surgery (OR=4.93, CI=3.82–6.36, p=0.0005), compared to bicycle collision.

Conclusion

Scrotal or testicular trauma is rare but occurs most commonly after assault by firearm. Most patients only have isolated scrotal or testicular trauma, but nearly half require subsequent scrotal or testicular operation. Trauma patients presenting after a motorcycle collision have a higher association of scrotal or testicular trauma and subsequent surgery when compared to those involved in a bicycle collision.

The Decrease in Traumatic Brain Injury Epidemics Deriving from Road Traffic Collision Following Strengthened Legislative Measures in France

Background

Since 2002, France has been strengthening legislation on road traffic. This study is intended to evaluate the changes in Traumatic Brain Injury (TBI) incidence and mortality resulting from Road Traffic Collision (RTC) in the two 6-year periods before and after 2002.

Methods

We used a Registry of all RTC casualties in the Rhône Department of France. Each casualty was coded according to the Abbreviated Injury Scale (AIS). The study describes changes in demographic variables, TBI (AIS ≥ 2) incidence and mortality, other body lesions (AIS ≥ 3) associated with TBI, road user types, seatbelt and helmet wearing.

Findings

RTC casualty occurrences decreased by 21% (from 64,312 to 50,746) during the period after 2002. TBI occurrence accounted for 8.6% and 6.7% of all RTC in both periods. This corresponds to a reduction of TBI casualty incidence (-42%), which was much more pronounced than RTC casualty incidence (-25%) (p < 0.0001). Severe and critical TBI (AIS-4 and -5) incidences were reduced by half as much (-21%), compared to TBI incidence. TBI mortality rate (among population) and lethality (among TBI related to RTC casualties) decreased 56% and 23%, respectively. This reduction particularly affected car occupants and victims who deceased. TBI incidence decreased 43% in all 10-year age classes until 60 on average, this decrease declining with age in the period after 2002. After adjustment for age, sex, road user types, and severity of lesions at the head and other body regions, logistic regression analysis displayed a protective effect of the period following 2002, on the risk of death after RTC-related TBI.

Interpretation

The greater reductions in the incidence, severity and mortality of TBI when compared with the reduction of casualty incidence have mainly affected car users. These results should be attributable to the improvements in standards of care, primary safety of the car fleet and general road architecture safety. However, the increased reduction in the TBI epidemics in France, when compared to those observed in other developed countries for the same periods, suggests that the effects should be strongly attributable to changes in road user behaviour induced by law enforcement. The at-risk groups for TBI after RTC are now two-wheel users (motorized or not) and individuals over 60 years of age.

A systematic review on the effectiveness of back protectors for motorcyclists

Background

Motorcyclists are a vulnerable road-user population who are overrepresented in traffic injuries. Utilisation of back protectors may be an effective preventive measure for spine injuries in motorcyclists. Since use of back protectors is increasing it is important that clinical evidence supports their use. The study aimed to investigate the current evidence on the ability of back protectors to reduce the rate of back injuries and patient mortality in motorcycle crashes.

Methods

A systematic literature search was conducted using various electronic databases. Systematic reviews, randomised controlled trials, controlled clinical trials, cohort studies, case series and case reports were included Opinion pieces and laboratory or biomechanical studies were excluded. Back protectors and spine protectors were included as the intervention; neck braces and speed humps were excluded. The target outcomes were any injuries to the back or death. Only English language studies were included.

Results

The search strategy yielded 185 studies. After excluding 183 papers by title and abstract and full-text evaluation, only two small cross-sectional studies were included. Foam inserts in motorcycle jackets and non-standard clothing may possibly be associated with higher risk of injuries, while hard shell and standard back protectors may possibly be associated with a reduced rate of back and spinal injury.

Conclusion

This systematic review highlighted lack of appropriate evidence on efficacy of back protectors. Based on limited information, we are uncertain about the effects of back protectors on spinal injuries. Further research is required to substantiate the effects of back protectors on mortality and other injuries to the back.

Electronic supplementary material

The online version of this article (doi:10.1186/s13049-016-0307-3) contains supplementary material, which is available to authorized users.

Fatal cervical spine injuries: a Finnish nationwide register-based epidemiologic study on data from 1987 to 2010

BACKGROUND CONTEXT

The number of cervical spine injuries (CSIs) is increasing. Cervical spine injuries are associated with high morbidity and mortality. Identifying those who are at risk for CSI-related death can help develop national and international interventions and policies to reduce mortality.

PURPOSE

This study aimed to determine the trends in the incidence and the characteristics of fatal CSIs in Finland over a 24-year study period from 1987 to 2010.

STUDY DESIGN/SETTING

A large nationwide, retrospective, register-based study was carried out.

PATIENT SAMPLE

The population-based sample was collected from death certificates issued in Finland between 1987 and 2010. The death certificates were obtained from the official Cause-of-Death Register, coordinated by Statistics Finland, which covers all deaths occurring in Finland.

OUTCOME MEASURES

Sociodemographics and injury- and death-related data were used for outcome measures.

METHODS

All death certificates issued in Finland (1987-2010) containing a CSI as the cause of death were carefully reviewed.

RESULTS

A total of 2,041 fatal CSIs were identified. These constituted 0.17% of all deaths in Finland within the study period. The average annual incidence of fatal CSIs was 16.5 per million (range: 12.5-21.2). The majority of the victims were male (72.9%) and had concurrent spinal cord injury (83.0%). Traffic accidents (40.1%) and falls (45.0%) were the most common injury mechanisms. Almost one-third (29.8%) of the deaths were alcohol-related. Among the young victims (<60 years) with upper CSI (C0-C2), the majority (91.8%) died within 24 hours post-injury. One-third of elderly victims' (≥60 years) CSI-related deaths occurred after 1 week post-injury and were mostly (74.2%) caused by respiratory and circulatory system diseases. Within the 24-year period, the incidence of fatal CSIs (+2/million), as well as the average age of sustaining a fatal CSI (+13.5 years), increased markedly. Fall-induced accidents among elderly males were the most prominently increasing subpopulation of fatal CSI victims.

CONCLUSIONS

In recent decades, fatal CSI incidence (death certificate-based) has increased, being 18.6 per million in Finland in 2010. Victims of fatal CSIs tend to be older than in the past, and for a substantial number of males, low-energy falls lead to cervical trauma and death.

Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland

Background

Traumatic spinal cord injury (TSCI) has a high personal and socio-economic impact. Effective public health prevention policies that aim to reduce this burden are reliant on contemporary information of the risk and underlying causes of TSCI. This study contextualizes Swiss annual incidence rates within the European context, and provides detailed estimates by age, gender and etiology towards informing targeted intervention strategies.

Methods

TSCI cases that occurred in the years 2005 to 2012 were identified as part of the Swiss Spinal Cord Injury (SwiSCI) cohort study through a rehabilitation-based study of local medical files.

Results

The crude annual incidence rate (IR) estimate of TSCI for the study period was 18.0 (95 % confidence interval 16.9–19.2) per one million population; standardized to the WHO world population IR was 21.7 (20.3–23.1) population. The injury rate of TSCI in Switzerland was intermediate in comparison to estimates for other European countries, which ranged from around 8.3 in Denmark to 33.6 per million in Greece. Males exhibited consistently higher IRs than females, with a highest IR ratio (IRR) of 3.9 (2.8–5.5) in young adults (aged 16 to 30). Sports and leisure and transport-related injuries were the predominant causes of TSCI in the youngest age group (aged 16 to 30); falls were the predominant cause among the oldest age group (76 years or over). With increasing age, a greater proportion of fall-related TSCIs were due to low-level falls, with more than 80 % of fall-related TSCIs due to low-level falls in the oldest age group.

Conclusions

Evidence suggests sports/leisure- and transport-related injuries in young men and falls among the elderly as prime targets for prevention policies and programs.

Mortality and longevity after a spinal cord injury: systematic review and meta-analysis

BACKGROUND/AIMS

Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population.

METHODS

A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI.

RESULTS

Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics.

CONCLUSION

This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.

The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients

CONTEXT/OBJECTIVE

Traumatic spinal cord injuries (T-SCI) have a devastating impact and place a significant financial burden on the healthcare system. The incidence of T-SCI ranges from 10.4 to 83 cases per million and varies with age, sex, or geographical region. This study describes the epidemiology and demographic characteristics of patients treated for T-SCI in our region over 11 years.

DESIGN

Retrospective cohort study.

SETTING

Single Level-I trauma center in Québec, Canada.

PARTICIPANTS

Patients who sustained T-SCI between 1 April 2000 and 31 March 2011.

INTERVENTIONS

None.

OUTCOME MEASURES

Data concerning T-SCI patients was retrieved from the Québec Trauma Registry. Information on age, sex, trauma, level of injury, type and severity of neurological deficit (ASIA scale), and treatment was extracted. Annual, age-standardized rates of T-SCI were calculated and trends over time were examined.

RESULTS

Eight hundred and thirty-one patients with T-SCI were identified. The incidence of T-SCI did not change over time but there was a 13-year increase in age between 2002 and 2010. More than 60% of patients aged 55 years or more were injured following a fall and 80% became tetraplegic. These patients were more likely to have central cord syndrome (CCS) and incomplete neurological injury, compared to younger patients. The incidence of CCS increased from 25 to 37% over 11 years.

CONCLUSIONS

The T-SCI population is aging and is more frequently sustaining injuries associated with CCS, incomplete neurological deficits and tetraplegia.

Incidence of traumatic spinal cord injury worldwide: a systematic review

PURPOSE

Traumatic spinal cord injuries (TSCI) are among the most devastating conditions in developed and developing countries, which can be prevented. The situation of TSCI around the world is not well understood which complicates the preventive policy decision making in fight against TSCI. This study was aimed to gather the available information about incidence of TSCI around the world.

METHODS

A systematic search strategy was designed and run in Medline and EMBASE, along with extensive grey literature search, personal communications, website searching, and reference checking of related papers.

RESULTS

Overall, 133 resources including 101 papers, 17 trauma registries, 6 conference proceedings, 5 books, 2 theses and 2 personal communication data were retrieved. Data were found for 41 individual countries. The incidence of TSCI ranges from 3.6 to 195.4 patients per million around the world. Australia, Canada, US, and high-income European countries have various valuable reports of TSCI, while African and Asian countries lack the appropriate epidemiologic data on TSCI.

CONCLUSION

Data of epidemiologic information in TSCI are available for 41 countries of the world, which are mostly European and high-income countries. Researches and efforts should be made to gather information in developing and low-income countries to plan appropriate cost-effective preventive strategies in fight against TSCI.