2005 NSCISC Annual Statistical Report for the Mode · Downey, CA Northern California SCI System -...

THE 2005 ANNUAL STATISTICAL REPORT

for the

MODEL SPINAL CORD INJURY CARE SYSTEMS

The National Spinal Cord Injury Statistical Center publishesscheduled statistical reports on the national database. Thesecomplete reports are available only to the currently participatingModel Systems. To the general public there is limited availabilityof statistics from these reports, i.e. some pages are omitted in thisversion.

This is a publication of the National Spinal Cord Injury Statistical Center, Birmingham, Alabama,which is funded by grant number H133A011201

from the National Institute on Disability and Rehabilitation Research,Office of Special Education and Rehabilitative Services. U.S. Department of Education.

The opinions contained in this publication are those of the granteeand do not necessarily reflect those of the U.S. Department of Education.

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TABLE OF CONTENTS

PagePart I: The National Spinal Cord Injury Statistical Center Activities

Patients by Year of Injury ........................................................................................... 31Table 5. Number of Patients by System and Year of Injury. ................................. 31Figure 2. Number of Patients by Year of Injury. ..................................................... 36

Cause of Death ............................................................................................................ 39Table 8. Primary Cause of Death ......................................................................... 41

Long Term Survival..................................................................................................... 42Table 9. Cumulative Survival................................................................................ 43

Life Expectancy........................................................................................................... 57Table 10. Life Expectancy for SCI Persons Surviving at least 24 Hours Post-injury ........57Table 11. Life Expectancy for SCI Persons Surviving at least 1 Year Post-injury........... 58

PART III: STATISTICAL ANALYSIS OF THE NATIONAL SCI DATABASE............... 61

Age At Injury................................................................................................................ 62Table 14. Age at Injury by System: Descriptive Statistics....................................... 62Table 15. Trend in Age by Year of Injury ................................................................ 62Table 16. Age at Injury: Frequency Distribution...................................................... 63

Sex................................................................................................................................ 64Table 17. Sex of Spinal Cord Injury Patients .......................................................... 64

Race.............................................................................................................................. 65Table 18. Race of Spinal Cord Injury Patients........................................................ 66

Hispanic Origin............................................................................................................ 67Table 19. Hispanic Origin by Race......................................................................... 67

Etiology........................................................................................................................ 68Table 20. Etiology of Spinal Cord Injury by Sex. .................................................... 69Figure 3. Grouped Etiology by Age At Injury. ........................................................ 71Figure 4. Grouped Etiology by Sex........................................................................ 72Figure 5. Grouped Etiology by Race...................................................................... 72Table 21. Grouped Etiology by Injury Year............................................................. 73Table 22. Grouped Etiology.................................................................................... 74

Work Relatedness ....................................................................................................... 75Table 23. Work relatedness.................................................................................... 75

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Marital Status............................................................................................................... 76Table 24. Marital Status at Time of Spinal Cord Injury ........................................... 77Table 25. Marital Status by Time Post-Injury.......................................................... 78

Level of Education ...................................................................................................... 79Table 26. Highest Level of Formal Education Completed at Time of Injury............ 80Table 27. Patients Who Obtained a High School Diploma within Five Years of Injury.....81Table 28. Patients with a High School Diploma at Injury Who Obtained

a Higher Degree within Five Years of Injury. .......................................... 82

Occupational Status.................................................................................................... 83Table 29. Occupational Status by Time Post-Injury................................................ 84Figure 6. Occupational Status by Year Post-Injury ................................................ 85Figure 7. Percent Employed by Year Post-Injury.. ................................................. 85

Job Census Code........................................................................................................ 86Table 30. Job Census Code at Injury ..................................................................... 87Table 31. Job Census Code by Year Post-injury.................................................... 88

Place of Residence...................................................................................................... 89Table 32. Place of Residence at Discharge ........................................................... 90Table 33. Place of Residence by Time Post-Injury................................................. 91

Days From Injury to SCI Care System Admission.................................................... 92Table 34. Mean Days from Injury to System Admission by Year of Injury .............. 92Table 35. Days from Injury to System Admission: Frequency Distribution ............. 95Figure 8. Number of Days from Injury to System Admission by Year of Injury. ..... 96

Days Hospitalized in the System's Acute Care and Rehab Units ........................... 97Table 36. Mean Days Hospitalized in the System's Acute Care Unit by Year of Injury ... 97Table 37. Mean Days Hospitalized in the System's Rehab Unit by Year of Injury........ 100Table 38. Mean Days Hospitalized in the System's Acute Care Unit by Year of

Injury and Neurologic Level and Extent of Injury .................................. 104Table 39. Mean Days Hospitalized in the System's Rehab Unit by Year of Injury and

Neurologic Level and Extent of Injury ................................................... 105Figure 9. Mean Days Hospitalized in the System’s Acute Care Unit by Year of

Injury and Neurologic Level. ................................................................. 106Figure 10. Mean Days Hospitalized in the System’s Rehab Unit by Year of Injury

and Neurologic Level............................................................................ 107

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Total SCI Care System Hospital Charges................................................................ 108Table 40. Total System Hospital Charges by Year of Injury ................................. 109Figure 11. Mean Total System Hospital Charges by Injury Year and Neurologic Level ....111

Sponsors of Care ...................................................................................................... 112Table 41. Sponsors of Care by Time Post-Injury.................................................. 113

Type of Reimbursement ........................................................................................... 114Table 42. Type of Reimbursement During the Initial Hospitalization Period ......... 115

Medical Case Manager.............................................................................................. 116Table 43. Medical Case Manager During the Initial Hospitalization/

Rehabilitation Period.............................................................................. 117Table 44. Medical Case Manager During Follow-Up ............................................. 118

Complications ........................................................................................................... 119Table 45. Number of Patients Developing Secondary Medical Complications

During System by Neurologic Impairment ............................................ 120Table 46. Percentage of Patients Developing Secondary Medical Complications

During the Post-Injury Years. ............................................................... 120

Pressure Ulcers During Rehab ................................................................................ 121Table 47. Frequency of Pressure Ulcers Developing During Rehab by

Grade and Anatomic Location. ............................................................. 122

Operative Procedures............................................................................................... 123Table 48. Frequency of Selected Operative Procedures Performed During

System Hospitalization. ........................................................................ 124Table 49. Frequency of Operative Procedures Performed During Follow-Up ...... 124

Neurologic Level and Extent of Lesion ................................................................... 125Figure 12. Percent of Patients by Neurologic Level of Lesion At Discharge.......... 126Table 50. Neurologic Level of Lesion at Discharge – Cervical Lesions................ 127Table 50. Neurologic Level of Lesion at Discharge – Thoracic Lesions ............... 128Table 50. Neurologic Level of Lesion at Discharge – Lumbar Lesions................. 129Table 50. Neurologic Level of Lesion at Discharge –

Sacral Lesions, Normal Neurologic and Unknown ............................... 130Table 51. Neurologic Impairment Category at Discharge ..................................... 131Figure 13. Neurologic Category at Discharge by Grouped Etiology. ..................... 132Figure 14. Neurologic Extent of Lesion at Discharge by Injury Year...................... 133

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ASIA Impairment Scale ............................................................................................. 134Table 52. ASIA Impairment Scale by Neurologic Level of Lesion at Discharge. .. 134Table 53. Change in Degree of Preserved Neurologic Function (ASIA Impairment

Scale) between Admission to and Discharge from the System................... 135

ASIA Motor Index Score ........................................................................................... 136Table 54. Mean ASIA Motor Index Scores at System Admission, Rehab Admission

and Discharge........................................................................................ 136

Functional Independence Measure.......................................................................... 137Table 55. Gain in the Functional Independence Measure (FIM) Motor Score Per Day

Spent in Rehabilitation by Neurologic Level and Extent of Injury at Discharge... 138

Respirator Use........................................................................................................... 139Table 56. Respirator Use at System Rehab Admission and at Discharge for

Persons with Tetraplegia and Paraplegia ............................................. 140Figure 15. Respirator Use at System Rehab Admission and at Discharge by Injury

Year and Neurologic Level of Lesion.................................................... 141

Bladder Management................................................................................................ 142Table 57A. Method of Bladder Management by Time Post-Injury- Males ............... 143Table 57B. Method of Bladder Management by Time Post-Injury- Females........... 144

Days Rehospitalized Post-Discharge ...................................................................... 145Table 58. Percentage of Patients Rehospitalized and Mean Total Days Rehospitalized

by Year Post-Injury. .............................................................................. 146Table 59. Frequency and Percentage of Each Cause of Rehospitalization by

Year Post-Injury.................................................................................... 147

Number of Hours of Outpatient Physical and/or Occupational Therapy,Outpatient Psychological and/or Vocational Counseling...................................... 148

Table 60. Number of Hours of Outpatient Physical and/or Occupational therapyPost-Discharge to the First Anniversary of Injury. ................................ 149

Table 61. Number of Hours of Outpatient Psychological and/or VocationalCounseling Post-Discharge to the First Anniversary of Injury............... 150

Interview Information................................................................................................ 151Table 62. How the Interview Was Conducted ...................................................... 152

Self-perceived Health Status.................................................................................... 153Table 63. Self-perceived Health Status ................................................................ 153

How Would You Rate Your Health?......................................................................... 154Table 64. Compared to one year ago, how would you rate your health in general now? 154

Satisfaction with Life Scale...................................................................................... 155Table 65. Satisfaction with Life Scale - Total Score ............................................. 156

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The CHART ................................................................................................................ 157Table 66. CHART Physical Independence Subscale Score ................................. 158Table 67. CHART Cognitive Independence Subscale Score ............................... 159Table 68. CHART Mobility Subscale Score.......................................................... 160Table 69. CHART Occupational Status Subscale Score ...................................... 161Table 70. CHART Social Integration Subscale Score .......................................... 162Table 71. CHART Economic Self-Sufficiency Subscale Score ............................. 163Table 72. Total CHART Score.............................................................................. 165

The CHIEF.................................................................................................................. 166Table 73. CHIEF Policies Subscale Score ........................................................... 167Table 74. CHIEF Physical/Structural Subscale Score .......................................... 168Table 75. CHIEF Work/School Subscale Score ................................................... 169Table 76. CHIEF Attitudes/Support Subscale Score ............................................ 170Table 77. CHIEF Services/Assistance Subscale Score........................................ 171Table 78. CHIEF Total Score ............................................................................... 173

Patient Health Questionnaire ................................................................................... 174Table 79. Major Depressive Syndrome During Follow-Up...................................... 174Table 80. Severity of Depression Score During Follow-Up .................................... 175

Illegal Drug Use......................................................................................................... 176Table 81. Drug Use During Follow-Up.................................................................... 176

Alcohol Use ............................................................................................................... 177Table 82. Alcohol Use During Follow-Up.............................................................. 177Table 83. Alcohol Use – Number of Days Per Week During Follow-Up ............... 177Table 84. Alcohol Use – Number of Drinks, Cumulative Frequency..................... 178Table 85. Alcohol Use – Number of Times During the Past Month Having More

than 5 Drinks ........................................................................................ 179Table 86. CAGE Total Score................................................................................ 180

Pain............................................................................................................................. 181Table 87. Severity of Pain Score.......................................................................... 181Table 88. Pain Interfering with Work .................................................................... 182

Bibliography.............................................................................................................. 183

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2005Annual Statistical Report, July, 2005

The National SCI Database

All data submitted to the NSCISC by April 2005 are included in this report. As of 1 June2005, the National SCI Database contained information on 23,683 patients with 109,277Form II follow-up records. The combined total of Registry, Form I and Form II records inthe National SCI Database is 142,153 records.

National SCI Statistical Center

In 1983, the University of Alabama at Birmingham's Department of RehabilitationMedicine received federal grant funds to establish a national SCI data center. The UABoperation succeeded the National Spinal Cord Injury Data Research Center that servedthe Model SCI Care Systems Project between 1973 and 1981. Today, UAB's NationalSpinal Cord Injury Statistical Center (NSCISC) supervises and directs the collection,management and analysis of the world's largest spinal cord injury database.Organizationally, UAB's SCI Statistical Center is at the hub of a network of 16 federally-sponsored regional Model Spinal Cord Injury Care Systems located at major medicalcenters throughout the United States. In each of these settings, SCI Care Systempersonnel collect and submit acute, rehabilitation and follow-up (viz. annual, long-termpost-discharge) data on SCI patients who received care in the "System" following injury.

To assure comparability of data acquired by personnel in various centers, rigid scientificcriteria have been established for the collection, management and analysis ofinformation entered into the database. Moreover, NSCISC staff have developed qualitycontrol procedures that further enhance the reliability and validity of the database.

The16 Model SCI Systems funded for the 2000-2005 Project Period are:

AlabamaUniversity of Alabama at Birmingham SCI Care System -- UAB Spain Rehabilitation CenterBirmingham, AL

CaliforniaRegional SCI Care System of Southern California -- Rancho Los Amigos Med CenterDowney, CA

Northern California SCI System - Santa Clara Valley Medical CenterSan Jose, CA

ColoradoRocky Mountain Regional SCI System -- Craig HospitalEnglewood, CO

FloridaSouth Florida SCI System -- University of Miami School of MedicineMiami, FL

GeorgiaGeorgia Regional SCI System - Shepherd CenterAtlanta, GA


MassachusettsNew England Regional SCI Center -- Boston University Medical CenterBoston, MA

MichiganUniversity of Michigan Model SCI System -- University of Michigan Medical CenterAnn Arbor, MI

MissouriMissouri Model SCI System -- Univ Missouri-Columbia, Dept PM&RColumbia, MO

New JerseyNorthern New Jersey SCI System -- Kessler Institute for RehabilitationWest Orange, NJ

New YorkMount Sinai SCI Model System -- Mt. Sinai Medical CenterNew York, NY

PennsylvaniaRegional SCI System of Delaware Valley -- Thomas Jefferson University HospitalPhiladelphia, PA

University of Pittsburgh Model Center on Spinal Cord Injury - University of PittsburghPittsburgh, PA

TexasTexas Regional SCI System -- The Institute for Rehabilitation & ResearchHouston, TX

VirginiaVCU/MCV SCI Model System -- Medical College of VirginiaRichmond, VA

WashingtonNorthwest Regional SCI System -- University of WashingtonSeattle, WA

Data from currently non-participating SCI systems (Chicago, Illinois; Columbus, Ohio;Detroit, Michigan; Milwaukee, Wisconsin; NYU, New York; Rochester, New York;Phoenix, Arizona; New Orleans, Louisiana; and Fishersville, Virginia) have beenincluded.

For more information:National Spinal Cord Injury Statistical Centerwww.uab.edu/NSCISC

Spinal Cord Injury Information Networkwww.spinalcord.uab.edu

National Institute on Disability and Rehabilitation Researchwww.ed.gov/about/offices/list/osers/nidrr


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PATIENTS BY YEAR OF INJURY

The number of patients entered into the National SCI Database by years of injury isdepicted in Table 5.

In 1987, criteria for enrollment in the National Database were changed by restrictingeligibility to patients admitted to the system within 60 days of injury (the previouscriterion was 1 year) and more narrowly defining system catchment areas. As a result,the number of new Form Is declined to just fewer than 700 per year. A further declineoccurred in 1990 as a result of the discontinued funding of four model systems.Although there were 705 patients added to the database in 1991, numbers dropped tounder 700 for the remainder of the 1990-1995 funding period. Thirteen systems werefunded during this period of time. During the next funding period (October 1995-September 2000), with 18 systems contributing data, the number of new patientsincreased to more than 700 each year. In October 2000, funding for 4 systems wasdiscontinued while 2 new systems were added. This change led to a slight decline innew patients during 2000. Data submission for 2004 and 2005 are incomplete at thistime.

n Year of Injury

% 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983

Total 223 402 579 684 822 848 1,007 1,130 818 750 1,155

0.9 1.7 2.4 2.9 3.5 3.6 4.3 4.8 3.5 3.2 4.9

n Year of Injury

% 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994

Total 1,098 975 931 663 628 645 597 705 651 654 689

4.6 4.1 3.9 2.8 2.7 2.7 2.5 3.0 2.7 2.8 2.9

n Year of Injury Total

% 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Total 638 736 755 729 766 673 719 727 692 578 16 23,683

2.7 3.1 3.2 3.1 3.2 2.8 3.0 3.1 2.9 2.4 0.1

Table 5. Number of patients by year of injury.


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Figure 2 (page 36) depicts the total number of system patients (i.e., Form I records) byyear of injury. As may be noted, more patients were reported in 1983 than in any otheryear. There was an upward trend in each year prior to cessation of the National SpinalCord Injury Data Research Center (NSCIDRC) operations in 1981. This trend was due,in part, to improved capture rates. The increasing number of federally-designated SCICare Systems also appears to have contributed to this upward trend.

Since NSCIDRC's successor, the UAB-SCI Data Management Service, did not initiateformal operations until March 1, 1983, the decline in patients entered into the databasein both 1981 and 1982 is undoubtedly the result of this interruption. The decline inpatients enrolled in the National SCI Database since 1984 is the result of fewer systemsbeing funded by NIDRR than in previous years.

New eligibility criteria were implemented in 1987 and account for the further decline inthe number of database patients. To reflect the impact of this change, Figure 2 includesthe number of Registry records in addition to the Form I records for each year of injury.

After 1995, Form Is are reported as “Day-1” (i.e., records for patients who enter thesystem within 24 hours of injury) and “Other” (i.e., patients who enter a system between2 to 60 days after injury). Less data are collected on the “Other” patients. In October2000, Form I eligibility was again expanded to patients admitted within 365 days ofinjury.

Data submissions for 2004 and 2005 are incomplete at this time.

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2005 Annual Statistical Report, July, 2005

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0

200

400

600

800

1000

1200

1400

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Figure 2. Number of patients by year of injury

Registry Form I Day1 Form I Other

n

Year of Injury


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CAUSE OF DEATH

All survival analyses in this report use the Collaborative SCI Survival Study databasemaintained at the NSCISC. This database contains considerably more patients than theNational SCI Database and much longer follow-up on individual patients through use ofthe Social Security Administration and Equifax. It includes Form I and Registry patientsas well as other patients treated at Model Systems who are not in the National SCIDatabase. This is also the database that was used to produce the chapter on long-termsurvival and causes of death that was included in the book Spinal Cord Injury: ClinicalOutcomes from the Model Systems. Therefore, these data represent an update of the1992 estimates provided in that book chapter as well as an update of the 2004 AnnualReport.

Primary cause of death for the 7,065 deceased patients in the Collaborative SCISurvival Study appears in Table 8 (page 41). Only persons injured since 1973 andtreated at a Model System within 1 year of injury were included in this analysis. Thenumber of deaths with unknown causes is high because many deaths identified throughEquifax computer search and the Social Security Death Index have not been followed-up by acquisition of death certificates. Therefore, 3,491 persons whose primary causeof death was unknown were not included in the calculation of any percentages. Theassumption is that unknown causes of death will be distributed the same way as knowncauses. These deaths of unknown causes are almost always persons who died afterdischarge. Therefore, causes of death that are more likely to occur after discharge,such as diseases of the genitourinary system, neoplasms, and accidents, suicides andhomicides may be somewhat underestimated proportionately.

Diseases of the respiratory system were the leading cause of death (71.7% of thesewere cases of pneumonia). Other heart disease ranked second; however, these wereoften unexplained heart attacks (54.2%, ICD9CM code 427.5), that usually do notrepresent a true underlying cause of death. Rather, they reflect the relatively poorquality of cause of death data and reporting practices on many death certificates of SCIpatients. Hence, mortality from other heart disease is probably overestimated.

The third leading cause of death was infective and parasitic diseases. These werevirtually always cases of septicemia (93.5%) and were usually associated withdecubitus ulcers, urinary tract or respiratory infections.

Hypertensive and ischemic heart disease was the fourth leading cause of deathfollowed by neoplasms. Specific locations of neoplasms included the lung (75 cases,28.8%); bladder and colon/rectum (18 cases each, 6.9%); prostate (15 cases, 5.8%);brain and leukemia (11 cases each, 4.2%); breast and liver (10 cases each, 3.8%);digestive system (9 cases, 3.5%), esophagus (8 cases, 3.1%); kidney and otherlymphoma (7 cases each, 2.7%); pancreas, testes and head/face/neck, (6 cases each,2.3%); multiple myeloma (4 cases, 1.5%); endocrine gland and melanoma (3 caseseach, 1.2%); peritoneum and ovary (2 cases each, 0.8%); and one case each of uterus,spinal cord, bone and thymus (0.4%). Twenty five neoplasms were reported to havedeveloped at an unspecified location (9.6%).


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Unintentional injuries were the sixth leading cause of death followed by diseases ofpulmonary circulation (97.2% of which were cases of pulmonary emboli). These deathsusually occurred prior to first definitive discharge.

Disease of the digestive system were the eighth leading cause of death, followed bysymptoms and ill-defined conditions and suicides. It should be noted that the categoriesof unintentional injuries, suicides, and homicides do not include any persons dying frommultiple injuries sustained during the original accident. However, they do includepersons involved in fatal events following discharge. If the 118 cases of subsequenttrauma of uncertain nature were divided proportionately between unintentional injuries,suicides, and homicides, then an additional 63 unintentional injuries, 44 suicides, and11 homicides took place, which would still make unintentional injuries the sixth leadingcause of death but make suicide the seventh leading cause of death.

The eleventh leading cause of death was cerebrovascular disease followed bygenitourinary system diseases. The dramatic reduction in deaths due to genitourinarysystem diseases such as renal failure (the leading cause of death in the past), isundoubtedly due to close monitoring of the urinary tract as well as advances in itsmedical management over the past two decades.


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ICD9CMCodes

Primary Cause of Death n %

460-519 Diseases of the respiratory system 782 21.9

420-429 Other heart disease 445 12.4

000-139 Infective and parasitic diseases 338 9.4

400-414 Hypertensive and ischemic heart disease 281 7.9

140-239 Neoplasms 260 7.3

E800-E949 Unintentional injuries 194 5.4

415-417 Disease of pulmonary circulation 179 5.0

520-579 Diseases of the digestive system 171 4.8

780-799 Symptoms and ill-defined conditions 161 4.5

E950-E959 Suicides 135 3.8

430-438 Cerebrovascular disease 133 3.7

580-629 Diseases of the genitourinary system 131 3.7

E980-E989 Subsequent trauma of uncertain nature(unintentional/suicide/homicide)

118 3.3

320-389 Diseases of the nervous system and sense organs 59 1.6240-279 Endocrine, nutritional, metabolic and immunity disorders

(includes AIDS)54 1.5

440-448 Diseases of the arteries, arterioles, and capillaries 53 1.5E960-E969 Homicides 35 1.0

290-319 Mental disorders 11 0.3

451-459 Diseases of veins, lymphatics, and other diseases of thecirculatory system

10 0.3

710-739 Diseases of the musculoskeletal system and connectivetissue 9 0.3

740-759 Congenital anomalies 5 0.1

Residual All others 4 0.1

280-289 Diseases of blood and blood-forming organs 4 0.1E970-E979 Legal intervention 2 0.1

Total known causes of death 3,574

Total unknown causes of death 3,491

Total deaths 7,065

Table 8. Primary cause of death.


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LONG TERM SURVIVAL

Table 9 (page 43) presents cumulative survival for the entire National SCI Database. Datafor currently non-participating systems are included in the national table.

Patients were considered Withdrawn Alive if a follow-up form (Form II) for 2003 or laterwas submitted indicating the patient was known to be alive, if the patient's follow-up wasdiscontinued due to neurologic recovery or transfer to another SCI Care System, or ifSocial Security Death Index searches performed in 2005 did not indicate a reported death.The proportion of patients dying in each post-injury year ranged from 4.46 percent in yearone to 1.29 percent in year 10. Annual death rates for those who survived the first post-injury year average 1.95 percent and increase over time as the population ages.

The cumulative 20-year survival rate for patients with spinal cord injury was 70.05 percent.However, because of the high proportion of losses to follow-up, as well as the knownunderreporting of spinal cord injury fatalities occurring shortly after injury, this informationshould be interpreted with caution. It is likely some patients were lost to follow-up becausethey died. Therefore, these annual mortality rates may be underestimated.


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YearsPostInjury

(1)PatientsEntered

(2)Withdraw

n Alive

(3)Lost

(4)Dead

(5)EffectiveNumberExposed

(6)Proportion

Dead

(7)ProportionSurviving

(8)CumulativeSurvival at

End ofInterval

0 - 1 36,641 1,660 4,629 1,493 33496.5 0.0446 0.9554 0.95541 - 2 28,859 890 1,334 585 27747.0 0.0211 0.9789 0.93532 - 3 26,050 457 672 394 25485.5 0.0155 0.9845 0.92083 - 4 24,527 274 394 372 24193.0 0.0154 0.9846 0.90674 - 5 23,487 331 475 327 23084.0 0.0142 0.9858 0.89385 - 6 22,354 718 696 288 21647.0 0.0133 0.9867 0.88196 - 7 20,652 600 305 303 20199.5 0.0150 0.9850 0.86877 - 8 19,444 630 280 297 18989.0 0.0156 0.9844 0.85518 - 9 18,237 577 219 245 17839.0 0.0137 0.9863 0.84349 - 10 17,196 698 239 216 16727.5 0.0129 0.9871 0.832510 - 11 16,043 869 347 244 15435.0 0.0158 0.9842 0.819311 - 12 14,583 790 154 195 14111.0 0.0138 0.9862 0.808012 - 13 13,444 767 111 201 13005.0 0.0155 0.9845 0.795513 - 14 12,365 668 46 192 12008.0 0.0160 0.9840 0.782814 - 15 11,459 656 71 191 11095.5 0.0172 0.9828 0.769315 - 16 10,541 624 143 162 10157.5 0.0159 0.9841 0.757016 - 17 9,612 623 20 174 9290.5 0.0187 0.9813 0.742917 - 18 8,795 625 9 160 8478.0 0.0189 0.9811 0.728818 - 19 8,001 600 5 152 7698.5 0.0197 0.9803 0.714519 - 20 7,244 542 18 136 6964.0 0.0195 0.9805 0.700520 - 21 6,548 705 111 112 6140.0 0.0182 0.9818 0.687721 -22 5,620 549 13 115 5339.0 0.0215 0.9785 0.672922 - 23 4,943 498 3 122 4692.5 0.0260 0.9740 0.655423 - 24 4,320 597 2 102 4020.5 0.0254 0.9746 0.638824 - 25 3,619 658 16 76 3282.0 0.0232 0.9768 0.624025 - 26 2,869 583 65 70 2545.0 0.0275 0.9725 0.606826 - 27 2,151 458 6 50 1919.0 0.0261 0.9739 0.591027 – 28 1,637 459 0 40 1407.5 0.0284 0.9716 0.574228 – 29 1,138 398 0 30 939.0 0.0319 0.9681 0.555929 - 30 710 303 0 16 558.5 0.0286 0.9714 0.540030 - 31 391 259 0 5 261.5 0.0191 0.9809 0.529631 - 32 127 127 0 0 63.5 0.0000 1.0000 0.5296Total 36,641 19,193 10,383 7,065

Table 9. Cumulative survival - National.

(1) Number of individuals alive at start of interval.(2) Number of individuals alive at start of interval ineligible for further follow-up due to study termination.(3) Number of individuals lost to follow-up (survival status was unknown) during the interval.(4) Number of individuals dying during the interval.(5) Number of individuals exposed to risk of dying in interval [patients entered - 0.5 * (withdrawn alive + lost)].(6) Conditional probability of death during the interval (dead / effective number exposed).(7) Conditional probability of surviving the interval (1 - proportion dead).(8) Cumulative survival rate (previous cumulative survival * proportion surviving present interval).


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LIFE EXPECTANCY

Life expectancies for SCI patients by age at injury (in 5-year intervals) and neurologiclevel and extent of lesion appear in Table 10. All persons who survived at least 24hours after injury and who were included in the collaborative SCI survival studydatabase were included in this analysis. Comparable figures for persons who survivethe first post-injury year, by current age, appear in Table 11 (page 58). For eachneurologic category the observed number of deaths was compared to an expectednumber of deaths based on observed length of follow-up and 1993 age-sex-specificmortality rates for the general U.S. population using methods outlined in detail by Smartand Sanders 1. The year 1993 was chosen because it was roughly the mid-year offollow-up for the SCI population. All follow-up data through 2005 were used.

Life Expectancy (Years)

Age No Not Ventilator Dependent VentilatorDependent

At SCI MotorFunctional

Paraplegia

Tetraplegia Any Level

Injury Any Level C5-C8 C1-C4

10 years 67.9 62.2 54.7 49.4 44.8 23.215 years 63.0 57.3 49.8 44.6 40.0 19.020 years 58.2 52.6 45.3 40.2 35.9 16.425 years 53.5 48.0 40.9 36.1 31.9 14.330 years 48.7 43.3 36.4 31.8 27.9 11.835 years 44.0 38.7 32.0 27.6 23.8 9.240 years 39.3 34.1 27.7 23.5 20.0 6.945 years 34.8 29.8 23.6 19.7 16.5 5.150 years 30.3 25.5 19.8 16.2 13.3 3.655 years 26.1 21.5 16.1 12.9 10.3 2.460 years 22.0 17.7 12.8 10.0 7.8 1.465 years 18.2 14.2 9.9 7.4 5.6 0.670 years 14.7 11.1 7.4 5.3 3.8 0.175 years 11.5 8.3 5.2 3.6 2.5 <0.180 years 8.8 6.0 3.5 2.2 1.4 <0.1

Table 10. Life expectancy for SCI persons surviving at least 24 hours post-injury.[Values for persons with no SCI are from the 2002 U.S. Life Tables for the generalpopulation.]


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Life Expectancy (Years)Current No Not Ventilator Dependent Ventilator

DependentAge SCI Motor

FunctionalParaplegia Tetraplegia Any Level

Any Level C5-C8 C1-C410 years 67.9 62.9 55.3 50.6 46.8 30.915 years 63.0 58.0 50.5 45.8 42.1 26.420 years 58.2 53.2 45.9 41.4 37.8 23.125 years 53.5 48.6 41.5 37.2 33.8 20.230 years 48.7 43.9 37.0 32.9 29.6 17.135 years 44.0 39.3 32.6 28.6 25.5 13.940 years 39.3 34.7 28.3 24.4 21.5 10.945 years 34.8 30.3 24.1 20.6 17.9 8.450 years 30.3 26.0 20.3 17.0 14.5 6.355 years 26.1 22.0 16.6 13.6 11.4 4.560 years 22.0 18.1 13.2 10.6 8.7 3.065 years 18.2 14.6 10.3 8.0 6.4 1.870 years 14.7 11.4 7.7 5.8 4.5 1.075 years 11.5 8.6 5.5 3.9 2.9 0.380 years 8.8 6.2 3.7 2.5 1.7 <0.1

Table 11. Life expectancy for SCI persons surviving at least 1 year post-injury.[Values for persons with no SCI are from the 2002 U.S. Life Tables for the generalpopulation.]

The purpose of reporting these life expectancies is to document continuing progressattributable in large part to the Model System program. These figures are slightlydecreased from those contained in our last annual report. SMR values increased slightlydue to a shift in the reference year for calculating expected deaths from 1988 to 1993.The latter is a more accurate estimate of the mid-year of follow-up for this studypopulation. Life expectancies remain substantially below normal, particularly for personswith tetraplegia and ventilator-dependency.

Figures in these tables are generally not appropriate for use in assessing lifeexpectancy of individual persons because they are not specific enough for that task. Atminimum, important prognostic factors that should be considered in determining anindividual life expectancy include age, exact neurologic level of injury (particularlyamong persons with tetraplegia), ASIA impairment scale, length of survival that hasalready occurred post-injury, and to a lesser extent, etiology of injury, gender and race2.Significant co-morbidities (cancer, heart disease, diabetes, etc.) should also beconsidered when present3.

Methods for estimating life expectancy that are used by the NSCISC are detailed in tworecent articles by Strauss et al. and DeVivo3, 4.


61

Part III

Statistical Analysis of the National SCI Database

Introduction

The tables and figures presented in this report are based on a statistical analysis of most of thevariables in the National SCI Database. For most of these variables, each system has beenprovided with tables reflecting its own patient population. The narrative accompanying thetables and figures, however, is restricted to analysis of national aggregate data and intersystemvariability within the database.

Lost and Unknown Categories

Since differential losses to follow-up may mask time trends within the data, patients who are lostare not included in the tables and figures depicting post-discharge data. The underlyingassumption is made that patients who are lost to follow-up will be distributed proportionatelyacross categories in the same way as successfully followed patients.Data classified as unknown represent those patients who are being followed but for whom thatspecific information is unavailable. Therefore, a high proportion of unknowns indicatesinformation reflecting unusual data collection difficulties.

Data from the Extended Data Submission Years

Since 1995 revised Form II reporting procedures require submission of Form IIs for all patientsonly in post-injury years 1, 2, 5, 10, 15, 20, 25 and 30. For this reason, there has been asignificant decrease in the numbers of records in all the other post-injury years. Therefore,beginning with this report, several Form II analyses have been restricted only to the extendeddata years.

Statistical Measures

The measure of central tendency used was the mean, or arithmetic average, which is simply thesum of the individual values for each patient divided by the number of patients. The standarddeviation (S.D.) is a measure of dispersion about the population mean (i.e., how closelyindividual patient values cluster around the mean). If data are normally distributed, 95 percentof all observed values will fall within 1.96 standard deviations of the mean.Because most of the continuous variables in the National SCI Database are not normallydistributed, appropriate transformations were made before these data were analyzed. Thesquare root transformation was determined to be the most appropriate (i.e., it led to the mostnearly normal distribution based on convergence of the mean, median and mode as well asskewness and kurtosis coefficients approaching zero). The transformation involves taking thesquare root of the original raw data, then calculating the mean and standard deviation andfinally, squaring the resulting mean for reporting purposes. However, it is not appropriate tosquare the resulting standard deviation. Therefore, we have chosen to report the 95 percentconfidence limits, which are calculated from the mean and standard deviation (in square rootterms) as follows:

Lower 95 percent confidence bound = [mean - 1.96 (S.D.)]2Upper 95 percent confidence bound = [mean + 1.96 (S.D.)]2

Because of the transformation, the confidence interval is not symmetric about the mean.Nonetheless, the implication is that 95 percent of the data should be between the reported upperand lower bound.


62

AGE AT INJURY

The occurrence of spinal cord injury is highest among persons in the 16-30 age group.In fact, more injuries occurred in this age group than in all other age groups combined.Some descriptive statistics for the age at injury distribution are shown in Table 14 Meanage for all patients was 32.8 years (S.D. = 15.9). Mean age for all patients in thedatabase ranged from a low of 28.9 to a high of 44.4.

Mean Standard Deviation n Minimum Maximum

Total 32.8 15.9 23,682 <1 98

Table 14. Age at injury: descriptive statistics. [1 case had incomplete data.]

Table 15 reflects a consistent trend toward older age at time of injury. Mean age atinjury has increased from 28.7 years between 1973 and 1979 to 37.6 years since 2000.This trend reflects in large part a similar trend in the average age of the United Statespopulation. However, underlying changes in age-specific spinal cord injury incidencerates, changing locations of model systems, and changing referral patters to modelsystems may also be contributing to the trend toward older age at injury for persons inthe NSCISC database.

Year of Injury Mean Standard Deviation n Minimum Maximum

1973 – 1979 28.7 14.1 4,564 1 88

1980 – 1984 30.5 14.6 4,951 1 90

1985 – 1989 32.3 15.8 3,842 <1 92

1990 – 1994 33.7 15.9 3,296 1 97

1995 - 1999 36.4 16.9 3,624 <1 98

2000 - 2005 37.6 16.7 3,405 4 90

Table 15. Trend in age by year of injury. [1 case had incomplete data.]


63

The cumulative frequency distribution of age at injury is depicted in Table 16. Threepatients were less than one year old while one was 98 years old. The most commonage was 19 years; 30.0 percent of all injuries occurred between the ages of 17 and 23years, and 52.6 percent of all injuries occurred between the ages of 16 and 30.Approximately 8.6 percent of all injuries occurred at age 60 or older.

Age n Frequency CumulativeFrequency Age n Frequency Cumulative

Frequency<1 3 <0.1 <0.1 49 220 0.9 84.11 11 <0.1 0.1 50 201 0.8 85.02 9 <0.1 0.1 51 177 0.7 85.73 15 0.1 0.2 52 204 0.9 86.64 21 0.1 0.2 53 187 0.8 87.35 14 0.1 0.3 54 183 0.8 88.16 19 0.1 0.4 55 167 0.7 88.87 16 0.1 0.5 56 176 0.7 89.68 18 0.1 0.5 57 168 0.7 90.39 18 0.1 0.6 58 153 0.6 90.9

10 29 0.1 0.7 59 146 0.6 91.511 15 0.1 0.8 60 145 0.6 92.212 33 0.1 0.9 61 155 0.7 92.813 95 0.4 1.3 62 122 0.5 93.314 195 0.8 2.2 63 118 0.5 93.815 360 1.5 3.7 64 114 0.5 94.316 693 2.9 6.6 65 93 0.4 94.717 956 4.0 10.6 66 114 0.5 95.218 1,125 4.8 15.4 67 121 0.5 95.719 1,162 4.9 20.3 68 95 0.4 96.120 1,028 4.3 24.6 69 80 0.3 96.421 1,007 4.3 28.9 70 71 0.3 96.722 943 4.0 32.9 71 75 0.3 97.023 882 3.7 36.6 72 63 0.3 97.324 817 3.4 40.0 73 73 0.3 97.625 764 3.2 43.3 74 61 0.3 97.926 687 2.9 46.2 75 69 0.3 98.227 645 2.7 48.9 76 63 0.3 98.428 620 2.6 51.5 77 62 0.3 98.729 613 2.6 54.1 78 39 0.2 98.930 547 2.3 56.4 79 49 0.2 99.131 530 2.2 58.7 80 36 0.2 99.232 526 2.2 60.9 81 31 0.1 99.333 434 1.8 62.7 82 26 0.1 99.534 368 1.6 64.3 83 28 0.1 99.635 428 1.8 66.1 84 17 0.1 99.636 422 1.8 67.8 85 19 0.1 99.737 371 1.6 69.4 86 16 0.1 99.838 387 1.6 71.0 87 11 <0.1 99.839 327 1.4 72.4 88 12 0.1 99.940 331 1.4 73.8 89 8 <0.1 99.941 319 1.3 75.2 90 6 <0.1 100.042 290 1.2 76.4 91 4 <0.1 100.043 294 1.2 77.6 92 3 <0.1 100.044 281 1.2 78.8 94 1 <0.1 100.045 277 1.2 80.0 95 1 <0.1 100.046 241 1.0 81.0 97 1 <0.1 100.047 251 1.1 82.1 98 1 <0.1 100.048 260 1.1 83.2

Table 16. Age at injury: frequency distribution. [1 case had incomplete data]


64

SEX

The number of spinal cord injury patients by gender is shown in Table 17. Overall, 81.1percent of all reported spinal cord injuries occurred among males.

There was very little variability among systems with regard to the composition of thepatient populations by gender. Among systems, the proportion of male patients rangedfrom a low of 75.6 percent to a high of 87.7 percent.

n%

Male Female

Total 19,208 4,475

81.1 18.9

Table 17. Sex of spinal cord injury patients.


65

RACE

The number of spinal cord injury patients by race is shown in Table 18 (page 65). Therewas substantial variability among systems: the proportion of white patients ranges from22.6 percent to 89.7 percent, while the proportion of African Americans ranged from 3.6to 52.1 percent. One system had the highest proportion of American Indians with 2.7%and another system had the highest proportion of patients of Asian descent with 5.6%.

A very significant trend over time was reported in the racial distribution of personsenrolled in the national database between 1973 and 19985. During 1973 through 197976.8% of persons enrolled in the database were white, 14.2% were African American,1.9% were American Indian, and 0.9% were Asian. However, after 1994, only 66.1%persons enrolled in the database were white, while 25.3% were African American, 2.1%were Asian, 0.4% were American Indian, and 2.9% were classified as “other” races.This trend is due in very small part to trends in the United States general population.Periodic changes in the identities of participating Model Systems, changes in eligibilitycriteria for inclusion into the National SCI Database, and changes in referral patterns toModel Systems are also partly responsible for this racial trend. However, the trend is solarge that changes in underlying race-specific SCI incidence rates are also likely.

It should not be inferred from these data that the incidence of spinal cord injury washigher among whites than non-whites. On the contrary, most patients were whitebecause whites comprise by far the largest segment of the United States population. Infact, other studies have demonstrated conclusively that the spinal cord injury incidencerate was highest among non-whites6.

High percentages of unknowns in this variable are due to a database conversionprocess that occurred in 1995. Details on this conversion are explained on page 67 ofthis report. All but 33, (2.0%) of the persons of unknown race are persons of Hispanicorigin.

Race Hispanic

n White African American Asian Other Unknown Origin with

% American Indian Race Unknown

Total 15,966 5,212 225 369 298 1,613 1,58067.4 22.0 1.0 1.6 1.3 6.8

Table 18. Race of spinal cord injury patients.


67

HISPANIC ORIGIN

Table 19 presents an analysis of the Hispanic Origin variable that was added to thedatabase in November 1995. This variable was added to conform to the Bureau of theCensus guidelines for reporting race and ethnicity.

When this variable was added, all persons coded Spanish in the race variable wereconverted to "Yes, Hispanic origin" in this variable and, their race was then changed toUnknown. For those who were not coded Spanish in the race variable, the "No" codewas inserted in this variable and their original race code was retained. This dataconversion process resulted in high percentages of records coded “unknown” in therace variable.

Race

Hispanic n White African American Asian Other Unknown TotalOrigin % American Indian

Not of 15,523 5,095 221 356 86 1 21,282Hispanic Origin 97.2 97.8 98.2 96.5 28.9 0.1 89.9Hispanic 380 51 4 12 212 1,580 2,239Origin 2.4 1.0 1.8 3.3 71.1 98.0 9.5Unknown 63 66 0 1 0 32 162

0.4 1.3 0.0 0.3 0.0 2.0 0.7

Total 15,966 5,212 225 369 298 1,613 23,683100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 19. Hispanic origin by race.


68

ETIOLOGY

Specific etiologic categories by sex are depicted in Table 20 (page 69). For males andfemales, the three leading causes of spinal cord injury were the same: auto accidents,falls, and gunshot wounds.

Among males, diving accidents ranked fourth followed by motorcycle accidents.However, for females, medical/surgical complications ranked fourth and divingaccidents ranked fifth.

Significant gender differences are evident in five etiologies: auto accidents (30.8% formales, 50.9% for females); motorcycle accidents (6.7% males, 1.9% females); divingaccidents (7.7% males, 2.9% females); hit by falling objects (3.7% males, 0.6%females) and medical/surgical complications (1.7% male, 4.2% females). Winter sportsand other Sports are the only etiologic categories in which the percentages are equal forboth genders.

It should be noted that the ATV/ATC category was created in October 1986; before thattime, injuries resulting from these vehicles were coded as either Motorcycle or OtherVehicle. While some systems have converted pre-1986 data where possible, thisconversion was not mandatory. Therefore, the number of injuries resulting fromATV/ATC accidents is most probably underreported.


69

Males Females TotalRank Etiologyn % n % n %

1 Auto accident 5,912 30.8 2,278 50.9 8,190 34.62 Fall 3,824 19.9 843 18.8 4,667 19.73 Gunshot 3,355 17.5 480 10.7 3,835 16.24 Diving 1,471 7.7 130 2.9 1,601 6.85 Motorcycle 1,291 6.7 84 1.9 1,375 5.86 Hit by falling object 711 3.7 28 0.6 739 3.17 Medical/surgical complications 321 1.7 187 4.2 508 2.18 Pedestrian 303 1.6 97 2.2 400 1.79 Bicycle 253 1.3 25 0.6 278 1.2

10 Personal contact 182 0.9 53 1.2 235 1.011 Other penetrating wound 176 0.9 47 1.1 223 0.912 Other Unknown 197 1.0 18 0.4 215 0.913 Other vehicular 129 0.7 15 0.3 144 0.614 Football 124 0.6 0 <0.1 124 0.515 Snow skiing 105 0.5 13 0.3 118 0.516 ATV/ATC 95 0.5 18 0.4 113 0.517 Horseback riding 52 0.3 54 1.2 106 0.418 Winter sports 78 0.4 17 0.4 95 0.419 Fixed wing aircraft 57 0.3 26 0.6 83 0.420 Other sports 66 0.3 14 0.3 80 0.320 Surfing 79 0.4 1 <0.1 80 0.322 Wrestling 74 0.4 2 <0.1 76 0.323 Trampoline 49 0.3 8 0.2 57 0.224 Gymnastics 29 0.2 18 0.4 47 0.225 Field sports 36 0.2 1 <0.1 37 0.226 Snowmobile 30 0.2 4 0.1 34 0.127 Hang gliding 29 0.2 2 <0.1 31 0.128 Rotating wing aircraft 26 0.1 2 <0.1 28 0.128 Water skiing 27 0.1 1 <0.1 28 0.130 Boat 18 0.1 7 <0.1 25 0.131 Air sports 21 0.1 0 <0.1 21 0.132 Baseball 19 0.1 0 <0.1 19 0.133 Rodeo 18 0.1 0 <0.1 18 0.134 Explosion 13 0.1 1 <0.1 14 0.135 Basketball 10 0.1 0 <0.1 10 <0.136 Track and field 5 <0.1 0 <0.1 5 <0.137 Skateboard 4 <0.1 0 <0.1 4 <0.1

Unknown 19 <0.1 1 <0.1 20 0.1Total 19,208 81.1 4,475 18.9 23,683 100.0

Table 20. Etiology of spinal cord injury, by sex.


70

The various etiologies were grouped into five categories, and the results are depicted inFigures 3, 4 and 5 and Tables 21 and 22. The Vehicular Accidents group consisted ofauto, motorcycle, ATV/ATC and other vehicular accidents, boating mishaps, accidentsinvolving fixed and rotating wing aircraft, snowmobile and bicycling accidents. TheViolence category included gunshot and other wounds, personal contact injuries andexplosions. The Other category included being hit by a falling object, pedestrianaccidents, medical/surgical complications and unclassified others. The remainingetiologic categories were considered Sports Accidents.

Grouped etiology by age at injury is depicted in Figure 3 (page 71). Vehicular Accidentswere the leading cause of spinal cord injury up to 60 years of age. After age 60, Fallswere the leading cause of SCI. Sports Accidents and Acts of Violence declinedproportionately while Falls increased with advancing age.


71

Figure 3. Grouped etiology by age at injury

Vehicular37.5%

Falls7.7%

Violence23.5%

Sports24.1%Other/Unknown

7.1%

0 to 15 Years

Vehicular44.3%

Falls22.5%

Violence16.8% Sports

6.9%

Other/Unknown9.4%

31 to 45 Years

Vehicular31.8%

Falls48.0%

Violence3.2%

Sports2.1%

Other/Unknown15.0%

61 to 75 Years

Vehicular46.4%

Falls10.7%

Violence23.0%

Sports14.7%Other/Unknown

5.3%

16 to 30 Years

Vehicular38.3%

Falls36.8%

Violence8.4% Sports

3.3%

Other/Unknown13.3%

46 to 60 Years

Vehicular27.6%

Falls60.7% Violence 1.6%

Sports 0.5%

Other/Unknown9.7%

76 to 98 Years


72

Figure 4 depicts grouped etiology by gender. Overall, 81.1 percent of all spinal cordinjuries were incurred by males. The Sports category differs the most from this overalldistribution: 89.8 percent of sports-related injuries were incurred by males.

Figure 4. Grouped etiology by sex

0102030405060708090

100% Male

76.1%86.5% 89.8%

81.9% 82.3%

Vehicular Violence Sports Falls Other

Figure 5 depicts grouped etiology by race. Overall, 67.4 percent of all spinal cordinjuries were incurred by whites. The distribution that differs most dramatically from theoverall trend is that of the Violence category, where less than one-third of the injurieswere incurred by whites.

Figure 5. Grouped etiology by race

010203040

5060708090

100% White

77.3%

88.0%

70.5% 73.2%

25.9%

Vehicular Violence Sports Falls Other


73

Grouped etiology by year of injury appears below in Table 21.

n Year of Injury AllEtiology

% 1973-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2005 Years

Vehicular 2,144 2,237 1,620 1,199 1,451 1,619 10,270

Accidents 47.0 45.2 42.2 36.4 40.0 47.5 43.4

Violence 605 792 723 952 764 471 4,307

13.3 16.0 18.8 28.9 21.1 13.8 18.2

Sports 655 706 390 248 254 304 2,557

14.3 14.3 10.2 7.5 7.0 8.9 10.8

Falls 752 836 796 659 845 779 4,667

16.5 16.9 20.7 20.0 23.3 22.9 19.7

Other 406 377 311 235 305 228 1,862

8.9 7.6 8.1 7.1 8.4 6.7 7.9

Unknown 3 3 2 3 5 4 20

0.1 0.1 0.1 0.1 0.1 0.1 0.1

Total 4,565 4,951 3,842 3,296 3,624 3,405 23,683100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 21. Grouped etiology by injury year.

Vehicular Accidents ranked as the leading cause of SCI through all time periods. Falls rankedsecond through all time periods except from 1990 to 1994 when Acts of Violence rankedsecond. There was a steady increase in the percentage of SCI due to Acts of Violence from13.3 percent prior to 1980 to 28.9 percent from 1990 to 1994. A concomitant decrease in thepercentage of SCI due to Sports-related activities from 14.3 to 7.5 occurred over this same timeperiod. The percentage of SCI due to Vehicular Accidents also decreased from 47.0% to36.4%. There has been a significant decline in SCI due to violence and an increase in injuriesdue to vehicular accidents and falls since 1994. These trends may be due in part to changinglocations of model systems, changing referral patterns to model systems, changes in underlyingincidence rates, or a combination of these factors.

Grouped etiology by system appears in Table 22 (page 73). Vehicular Accidents ranked first inthe National SCI Database (43.4%) and first in all but one system. Violence ranked first in thatsystem.

Falls ranked second nationally (19.7%) and second for all except five systems. Of those fivesystems sports ranked second in one, Vehicular Accidents ranked second in another, andviolence ranked second in the remaining three. Violence ranked third nationally (18.2%).

n Vehicular

% AccidentsViolence Sports Falls Other Unknown

Total 10,270 4,307 2,557 4,667 1,862 2043.4 18.2 10.8 19.7 7.9 0.1

Table 22. Grouped etiology.


75

WORK RELATEDNESS

This variable was added to the database in 2000 and only records entered after thatyear are included in Table 23. Of the 3,174 available records, 10.7% did have a workrelated spinal cord injury.

n

%No Yes Unknown Total

Total 2,775 339 60 3,17487.4 10.7 1.9

Table 23. Work relatedness.


76

MARITAL STATUS

Marital status at injury by system is depicted in Table 24 (page 76). It is not surprising,given the young age at which most injuries occur, that over half the patients in thedatabase were single (never married). Substantial intersystem variability was noted.The percentage of patients who were single at time of injury ranged from 43.0 percent intwo systems to 64.2 percent in another system. The percentage of married patientsranged from 20.8 percent to 40 percent, while the percentage of divorced patientsranged from 4.5 percent to 16.6 percent.

Table 25 (page 78) is a cross-sectional analysis of post-injury marital status. Only thedata from the follow-up years in which reporting is required for all patients arepresented. Most patients remain in the single, never married category through post-injury year 15.

Percentages of patients who are married as well as those who are divorced begin toincrease after year 5 and continue to increase through year 30.

n%

Single Married Divorced Separated Widowed Other Unknown

Total 12,013 7,398 2,135 879 575 25 14651.8 31.9 9.2 3.8 2.5 0.1 0.6

Table 24. Marital status at time of spinal cord injury.


78

Marital n Year Post-injuryStatus %

Discharge1 2 5 10 15 20 25 30

Single 7,049 1,986 970 1,068 628 453 377 221 1753.5 47.8 49.5 44.6 41.5 37.2 33.9 30.2 19.5

Married 4,228 1,370 604 772 497 417 382 304 4032.1 33.0 30.8 32.2 32.9 34.2 34.4 41.5 46.0

Divorced 1,184 511 234 403 297 273 296 171 279.0 12.3 11.9 16.8 19.6 22.4 26.6 23.3 31.0

Separated 437 148 87 76 46 31 30 9 13.3 3.6 4.4 3.2 3.0 2.5 2.7 1.2 1.1

Widowed 258 131 61 71 41 45 26 28 22.0 3.2 3.1 3.0 2.7 3.7 2.3 3.8 2.3

Other 15 8 5 4 3 0 0 0 00.1 0.2 0.3 0.2 0.2 0.0 0.0 0.0 0.0

Total 13,171 4,154 1,961 2,394 1,512 1,219 1,111 733 87100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 25. Marital status by time post-injury. (cross-sectional analysis using the last record withknown marital status for individuals who were at least 15 years of age at time of injury).


79

LEVEL OF EDUCATION

The highest level of formal education completed at time of injury by system appears inTable 26 (page 79). Slightly more than one half (58%) of the patients were at least highschool graduates at time of admission, whereas 84.6 percent were at least 19 years ofage at injury and would normally be expected to have completed high school.Approximately one-tenth (9.9%) had an eighth grade education or less, whereas only2.2 percent were less than 15 years of age at injury and would normally be expected tohave an eighth grade education or less.

The proportion of patients with an eighth grade education or less ranged from 0.7percent to 18.5 percent. Overall, the highest level of formal education completed attime of injury was reported as unknown for 6.3 percent of the patients, suggesting manysystems are having substantial difficulty collecting this information.

n to 8th Grades High Unknown% Grade 9-11 School

Assoc. Bachelor Masters Doctorate Other

Total 2,352 5,949 11,388 420 1,431 298 193 151 1,501

9.9 25.1 48.1 1.8 6.0 1.3 0.8 0.6 6.3

Table 26. Highest level of formal education completed at time of injury.


81

Table 27 depicts the number of patients with a ninth to eleventh grade level of educationat time of injury who obtained a high school diploma within five years post-injury. Onlythose patients whose education level was known at both admission and fifth annualexam were included in the analysis (n=2,228). The proportion of those patients whowent on to obtain their high school diploma ranged from 4.9 percent to 66.1 percent.

Obtained High School Diplomann %

Total 2,228 1,036 46.5Table 27 Patients who obtained a high school diploma within five

years of injury. [Includes only those with 9th to 11thgrade level of education at admission.]

Similarly, Table 28 depicts the number of patients with a high school diploma at time ofinjury who obtained a higher degree within five years post-injury. Again, only thosepatients whose education level was known at both admission and fifth annual examwere included in the analysis (n=4,433). The proportion of those patients who went onto obtain higher degrees ranged from 0.9 percent to 31.3 percent. It should be notedthat other than an Associate's Degree, any degree beyond high school usually takesfour or more years to complete; thus, five years post-injury may be too short a timeframe to indicate trends. It will be interesting to examine the changes in educationallevel as more follow-up data become available.

Obtained Post-High School Degreenn %

Total 4,433 571 12.9Table 28. Patients with a high school diploma at injury who obtained a

higher degree within five years of injury.

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham, 2005 Annual StatisticalReport, July, 2005

83

OCCUPATIONAL STATUS

Cross-sectional analysis of occupational status by time post-injury is shown in Table 29 (page84). Only the most recent record for subjects between ages 16 and 59 years of age with knownemployment status was included in this analysis and, data are presented only for the extendeddata years (i.e., the years in which data submission is required for all patients).

At admission, almost two-thirds (64.1%) of the patients were reported as employed in thecompetitive labor market while 15% were students and 16.4% were unemployed at injury.However, the post-injury employment pattern was strikingly different: only 13.6 percent wereemployed one year post-injury. This gradually increased to 37.3 percent by year twenty andpeaked in year thirty at 44.6 percent.

The proportion of patients who were homemakers remained relatively stable across all post-injuryyears, as did the proportion of retired patients. This was also true for the proportion of patients insheltered workshops and on-the-job training, both of which accounted for less than one percent.

The percentage of patients who were students as compared to both those who were employed orunemployed is depicted by year post-injury in Figure 6 (page 85). For these purposes,unemployed includes all categories except employed in the competitive labor market and student.The percentage of employed individuals rose from 14.3 percent in year one to 44.6 percent inyear thirty, while the proportion of those unemployed dropped from 71.5 percent in year one to52.7 percent in year thirty. The percentage of students peaked in year two at about 17 percent,then steadily declined in subsequent years. After year five, the percentage of employedindividuals rose as the proportion of students decreased, an indication that some former studentsbecame employed following the completion of their education.

The proportion of those employed in the competitive labor market by neurologic level of lesionthrough post-injury year thirty is depicted in Figure 7 (page 85). For persons with paraplegia, theproportion employed increased steadily over time: from 14.8 percent in the first post-injury year to48.5 percent in year thirty. For persons with tetraplegia, the proportion employed increased from13.5 percent in year one to 41.5 percent in year thirty.


84

n Time Post-injuryOccupation

% Admit 1 2 5 10 15 20 25 30

Working 8,057 525 252 512 403 395 393 260 3364.1 13.6 13.5 22.8 27.6 33.8 37.3 39.1 44.6

Homemaker 213 77 39 52 36 30 16 15 31.7 2.0 2.1 2.3 2.5 2.6 1.5 2.3 4.1

On-the-job 38 5 6 4 3 1 2 0 0training 0.3 0.1 0.3 0.2 0.2 0.1 0.2 0.0 0.0Sheltered 9 0 2 2 0 1 0 1 0Workshop 0.1 0.0 0.1 0.1 0.0 0.1 0.0 0.2 0.0Retired 88 54 31 78 54 50 44 41 6

0.7 1.4 1.7 3.5 3.7 4.3 4.2 6.2 8.1Student 1,890 520 289 313 101 48 33 13 2

15.0 13.5 15.5 13.9 6.9 4.1 3.1 2.0 2.7Unemployed 2,056 2,281 1,053 1,102 726 560 483 291 21

16.4 59.2 56.4 49.1 49.7 47.9 45.8 43.8 28.4Other 118 211 74 96 77 49 63 30 9

0.9 5.5 4.0 4.3 5.3 4.2 6.0 4.5 12.2Unknown 95 178 121 85 61 36 21 14 0

0.8 4.6 6.5 3.8 4.2 3.1 2.0 2.1 0.0Total 12,564 3,851 1,867 2,244 1,461 1,170 1,055 665 74

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0Table 29. Occupational status by time post-injury (cross-sectional analysis).


85

Figure 6. Occupational status by year post-injury.

Figure 7. Percent employed by year post-injury

0

10

20

30

40

50

60

70

80

1 2 5 10 15 20 25 30Year Post-injury

% Patients

Employed Unemployed Student

0

10

20

30

40

50

60

70

1 2 5 10 15 20 25 30Year Post-injury

% Patients

Paraplegia Tetraplegia


86

JOB CENSUS CODE

Job census code at injury, by system, appears in Table 30. This variable specifies the majorcensus occupational category for the patient’s occupation at the time of injury and during follow-up. It was added to the database in 2000. Only those records entered into the database since1999 (n=3,941) were used for this analysis. The following are the coding categories for thisvariable:

Code Category01 Executive, administrative, and managerial02 Professional specialty03 Technicians and related support04 Sales05 Administrative support including clerical06 Private household07 Protective service08 Service, except protective and household09 Farming, forestry, and fishing10 Precision production, craft, and repair11 Machine operators, assemblers, and inspectors12 Transportation and material moving13 Handlers, equipment cleaners, helpers, and laborers14 Military occupations

A plurality of persons (9.9%) was employed in precision production, craft, and repair jobs followedby professional specialty jobs (5.9%) and service jobs (4.8%). A high percentage of records werecoded unknown (23.9%) indicating some data collection difficulties.

Job census codes at follow-up appear in Table 31 (page 88). All records entered into thedatabase after 1999 are included in this analysis. More persons were employed in professionalspecialty jobs after injury than any other category, followed by executive, administrative andmanagerial jobs. These are typically jobs that require higher education levels and are also moreoften within the physical capabilities of persons with SCI than other job categories. These resultswould seem to reinforce the value of higher education degrees in obtaining and sustaining post-injury employment. Most persons with SCI do not have these advanced degrees, thereby makingit much more difficult to find suitable employment.

n Code Not Unknown% 01 02 03 04 05 06 07 08 09 10 11 12 13 14 Working

Total 154 233 75 116 98 14 39 189 76 389 83 113 204 5 1,213 940

3.9 5.9 1.9 2.9 2.5 0.4 1.0 4.8 1.9 9.9 2.1 2.9 5.2 0.1 30.8 23.9

Table 30. Job census code at injury.


88

Job Census n Year Post-injuryCode % 1 2 5 10 15 20 25 30

62 1 43 47 39 78 70 10012.4 0.2 2.8 4.4 4.2 7.8 9.0 10.974 4 72 86 76 105 82 12

022.8 0.8 4.8 8.0 8.2 10.6 10.6 13.017 0 22 17 13 18 16 3

030.7 0.0 1.5 1.6 1.4 1.8 2.1 3.328 3 31 26 18 12 10 2

041.1 0.6 2.0 2.4 2.0 1.2 1.3 2.235 2 39 28 24 41 28 3

051.3 0.4 2.6 2.6 2.6 4.1 3.6 3.3

1 0 0 3 0 1 0 006

<0.1 0.0 0.0 0.3 0.0 0.1 0.0 0.02 0 1 2 2 2 3 1

070.1 0.0 0.1 0.2 0.2 0.2 0.4 1.113 0 17 11 7 7 1 0

080.5 0.0 1.1 1.0 0.8 0.7 0.1 0.0

7 0 6 3 9 3 5 109

0.3 0.0 0.4 0.3 1.0 0.3 0.6 1.128 3 16 8 16 16 12 1

101.1 0.6 1.1 0.7 1.7 1.6 1.5 1.1

7 1 2 4 1 4 2 111

0.3 0.2 0.1 0.4 0.1 0.4 0.3 1.14 0 3 1 1 1 1 0

120.2 0.0 0.2 0.1 0.1 0.1 0.1 0.0

6 0 3 0 2 2 1 013

0.2 0.0 0.2 0.0 0.2 0.2 0.1 0.00 0 1 0 0 0 1 0

140.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0

Not 2,153 424 1,145 741 588 615 479 57Working 82.4 81.2 75.6 68.7 63.8 61.8 61.7 62.0Unknown 176 84 114 101 126 90 65 1

6.7 16.1 7.5 9.4 13.7 9.0 8.4 1.1

Total 2,613 522 1,515 1,078 922 995 776 92100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 31. Job census code by year post-injury.


89

PLACE OF RESIDENCE

Place of residence at discharge, by system, is shown in Table 32 (page 89). Table 33(page 89) depicts residence during the post-injury years using only each patient’s mostrecent Form II record and presenting the data for the extended data years only.

Most patients (88.1%) were discharged to a private residence. Intersystem variabilitywas not substantial: the proportion of patients discharged to a private residence rangedfrom 75.6 percent to 95.4 percent.

As at discharge, Private Residence ranked first in every year post-injury. Theproportion of patients residing in nursing homes never rose above 4.2% during anyextended data post-injury year.

n Private Nursing Group% Residence

HospitalHome Living

Other Deceased Unknown

Total 20,875 355 1,245 378 137 631 62

88.1 1.5 5.3 1.6 0.6 2.7 0.3

Table 32. Place of residence at discharge.

Place of Residence n Year Post-injury

% 1 2 5 10 15 20 25 30

Private Residence 3,911 1,815 2,322 1,492 1,228 1,116 747 8889.0 85.3 91.5 93.3 95.2 96.4 96.3 95.7

Hospital 24 19 6 3 0 0 1 00.5 0.9 0.2 0.2 0.0 0.0 0.1 0.0

Nursing Home 182 90 83 47 25 21 10 3

4.1 4.2 3.3 2.9 1.9 1.8 1.3 3.3

Group Living 45 37 25 10 5 2 1 01.0 1.7 1.0 0.6 0.4 0.2 0.1 0.0

Other 32 14 9 3 1 2 1 0

0.7 0.7 0.4 0.2 0.1 0.2 0.1 0.0

Unknown 198 153 93 44 31 17 16 1

4.5 7.2 3.7 2.8 2.4 1.5 2.1 1.1

Total 4,392 2,128 2,538 1,599 1,290 1,158 776 92

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 33. Place of residence by year post-injury. [cross-sectional analysis]


92

MEAN DAYS FROM INJURY TO SCI CARE SYSTEM ADMISSION

Table 34 (page 92) depicts mean days from injury to system admission by year of injury.Mean days from injury to system admission reached a peak of 23 days in 1975 and1976 and since that time, has declined steadily. A change in the eligibility criteriaimplemented in January 1987 has resulted in a further decrease in mean days frominjury to system admission. The new eligibility criteria allowed only patients admitted tothe system within 60 days of injury to be entered into the National SCI Database.Previously, patients were eligible for national data submission if they entered the systemwithin one year following injury. In 2000, eligibility was again expanded to one yearfollowing injury and as a result, mean days from injury to system admission increased to8 days in 2000, 2002 and 2004 and 10 days in 2003.

Year of Injury

1973 1974 1975 1976 1977 1978 1979n Mean n Mean n Mean n Mean n Mean n Mean n Mean

Total 223 19 402 21 579 23 684 23 822 21 848 22 1,007 22

Year of Injury1980 1981 1982 1983 1984 1985 1986

n Mean n Mean n Mean n Mean n Mean n Mean n Mean

Total 1,130 20 818 21 750 21 1,155 15 1,098 14 975 16 931 10

Year of Injury1987 1988 1989 1990 1991 1992 1993


Total 663 6 628 6 645 6 597 5 705 6 651 5 654 5

Year of Injury1994 1995 1996 1997 1998 1999

n Mean n Mean n Mean n Mean n Mean n Mean

Total 689 6 638 6 736 5 755 6 729 6 766 6

Year of Injury2000 2001 2002 2003 2004 2005


Total 673 8 719 7 727 8 692 10 578 8 16 6

Table 34. Mean days from injury to system admission by year of injury. [using squareroot transformation]


95

The actual distribution of days from injury to system admission for the entire NationalSCI Database is depicted in Table 35.

Days n % Cumulative% Days n % Cumulative

%1 10,391 43.9 43.9 32 192 0.8 80.02 380 1.6 45.5 33 169 0.7 80.73 315 1.3 46.8 34 148 0.6 81.34 335 1.4 48.2 35 116 0.5 81.85 319 1.3 49.6 36 142 0.6 82.46 321 1.4 50.9 37 156 0.7 83.17 285 1.2 52.1 38 158 0.7 83.88 318 1.3 53.5 39 148 0.6 84.49 373 1.6 55.0 40 109 0.5 84.8

10 353 1.5 56.5 41 105 0.4 85.311 343 1.4 58.0 42 102 0.4 85.712 342 1.4 59.4 43 101 0.4 86.113 299 1.3 60.7 44 111 0.5 86.614 252 1.1 61.8 45 105 0.4 87.115 270 1.1 62.9 46 121 0.5 87.616 316 1.3 64.2 47 118 0.5 88.117 327 1.4 65.6 48 89 0.4 88.418 307 1.3 66.9 49 72 0.3 88.719 292 1.2 68.1 50 85 0.4 89.120 244 1.0 69.2 51 85 0.4 89.521 228 1.0 70.1 52 77 0.3 89.822 253 1.1 71.2 53 97 0.4 90.223 248 1.0 72.3 54 95 0.4 90.624 234 1.0 73.2 55 74 0.3 90.925 229 1.0 74.2 56 56 0.2 91.126 233 1.0 75.2 57 72 0.3 91.527 162 0.7 75.9 58 84 0.4 91.828 177 0.7 76.6 59 65 0.3 92.129 173 0.7 77.4 60 77 0.3 92.430 244 1.0 78.4 >60 1,798 7.6 100.031 193 0.8 79.2

Table 35. Days from injury to system admission: frequency distribution.

Over forty-three percent were admitted to a spinal cord injury care system on the firstday post-injury. The substantial number of outliers and skewness of the distribution arealso reflected.

The percent of patients admitted to the systems within 1 day, 2 to 60 days and 61 to365 days by year of injury is depicted in Figure 8 (page 96). As mentioned, the revisedeligibility criteria have restricted database submissions to those patients admitted within60 days, thus eliminating the "61-365" days line from 1987 to 2000. Since this change,more than half of all patients have been admitted within one day of injury. Mostrecently, with the change back to the 365 day eligibility criteria, the percentage of day 1admissions has decreased slightly but still is almost 50 percent.


96

0

10

20

30

40

50

60

70

1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005

Year of Injury

% Patients

Within 1 day Within 2-60 days Within 60 - 365 days

Figure 8. Number of days from injury to system admission by year of injury.


97

DAYS HOSPITALIZED IN THE SYSTEM'S ACUTE CARE AND REHAB UNITS

The National SCI Database contains information on 10,391 patients admitted to the SCICare System within one day of injury. These were the only patients used in analyzingthe number of days hospitalized in the SCI Care System. Therefore, the resultingstatistics (Tables 36-39 and Figures 9 and 10) reflect lengths of stay for patients treatedentirely within the respective SCI Care Systems. Once again, the square roottransformation was used to obtain a more normal distribution.

Database revisions in November 1995 resulted in the separation of the single length ofstay variable into acute and rehab lengths of stay. Length of stay data in recordspresent at that time were separated based on formulas involving days from injury torehabilitation and total days hospitalized, with all short-term discharge days applied torehabilitation.

Tables 36 and 37 (pages 97 to 100) depict mean days in the system's acute care unitand rehab unit, respectively, by year of injury and system. Data for all years are shown.The data for 2005 and 2004 are incomplete and should be interpreted cautiouslybecause more severely injured patients with longer lengths of stay are usually the last tobe entered into the National SCI Database. Nonetheless, mean acute care length ofstay has declined from 28 days in 1973 to 13 days in 1997 but has since increasedslightly to 19 days in 2003. Mean rehabilitation length of stay has declined from 115days in 1974 to only 45 days in 2003.

Year of Injury1973 1974 1975 1976 1977 1978 1979


Total 73 28 103 25 178 26 196 24 237 20 228 20 293 23

Year of Injury1980 1981 1982 1983 1984 1985 1986


Total 358 26 258 23 218 29 459 24 433 21 329 23 429 22

Table 36. Mean days hospitalized in the system’s acute care unit by year of injury.[day-1 admissions, using square root transformation]


98

Year of Injury


Total 379 20 347 19 359 18 382 18 412 18 389 18 394 17

Year of Injury1994 1995 1996 1997 1998 1999


Total 376 16 351 15 410 15 401 13 406 15 397 16

Year of Injury

2000 2001 2002 2003 2004 2005n Mean n Mean n Mean n Mean n Mean n Mean

Total 322 18 356 17 354 15 291 19 243 17 7 8

Table 36. Mean days hospitalized in the system’s acute unit by year of injury.[day-1 admissions, using square root transformation] (continued)


100

Year of Injury1973 1974 1975 1976 1977 1978 1979


Total 64 96 97 115 161 113 182 102 219 99 203 91 257 94

Year of Injury


Total 333 99 249 87 198 88 435 86 421 82 310 75 401 74

Year of Injury


Total 356 80 329 76 344 68 372 65 387 67 360 63 368 55

Year of Injury1994 1995 1996 1997 1998 1999


Total 352 49 334 49 394 45 388 45 388 45 390 45

Year of Injury

2000 2001 2002 2003 2004 2005n Mean n Mean n Mean n Mean n Mean n Mean

Total 308 46 307 44 324 41 268 45 230 37 7 31

Table 37. Mean days hospitalized in the system’s rehab unit by year of injury.[day-1 admissions, using square root transformation]


103

Table 38 (page 104) depicts mean days hospitalized in the SCI Care System's acutecare unit by year of injury and neurologic level and extent of lesion. Table 39 (page105) presents the same analysis for length of stay in the system's rehab unit, andincludes only patients who actually spent time in rehabilitation.

Syllabus changes in October 1987 separated patients with minimal deficits from patientswho were neurologically normal. These categories (Paraplegia/Minimal andTetraplegia/Minimal) normally have few patients; however, the numbers are evensmaller due to the fact that it was not mandatory for systems to convert pre-1987 data.

Mean days hospitalized in the SCI Care Systems' acute and rehab units were greaterfor persons with tetraplegia than those with paraplegia. The only exceptions are acutelengths of stay during 1977, 1987, 1993 and 2002. In most years, the difference inacute care length of stay between persons with tetraplegia and paraplegia is relativelysmall, whereas differences in rehabilitation length of stay are substantial.

Mean days hospitalized in the acute care unit were usually greater for patients withneurologically complete cervical injuries than for patients with neurologically incompletecervical injuries. Excluding 2005 data, mean days hospitalized in the system's acutecare unit for persons with neurologically complete tetraplegia ranged from 46 in 1982 to16 in 1997, while for those with neurologically incomplete paraplegia, the comparablerange was from 29 days in 1973 and 1982 to 11 days in 1999.

Mean days hospitalized in the rehab unit were greatest for patients with neurologicallycomplete injuries. Excluding 2005 data, mean days hospitalized in the system's rehabunit for persons with neurologically complete tetraplegia ranged from 165 in 1976 to 53in 2004 while for those with neurologically incomplete paraplegia, the comparable rangewas from 89 days in 1975 to 30 days in 2001.

The overall trends observed for persons with paraplegia and those with tetraplegia aredepicted in Figures 9 and 10 (pages 106 and 107, respectively).


104

Level and Extent of InjuryYear Paraplegia Tetraplegia Total

of Incomplete Complete Minimal Total Incomplete Complete Minimal TotalInjury n Mean n Mean n Mean n Mean n Mean n Mean n Mean n Mean n Mean1973 12 29 20 26 - - 32 27 16 27 24 29 - - 40 28 72 281974 18 26 29 23 - - 47 24 23 19 33 32 - - 56 27 103 251975 28 24 51 21 - - 79 22 51 31 48 27 - - 99 29 178 261976 31 26 55 21 - - 86 23 54 20 47 31 - - 101 25 187 241977 39 20 74 20 - - 113 20 56 16 60 23 2 24 118 19 231 201978 35 18 52 17 - - 87 17 66 23 65 22 - - 131 23 218 201979 62 23 72 23 - - 134 23 83 26 61 22 1 18 145 24 279 241980 70 27 90 25 - - 160 26 108 27 80 27 1 13 189 27 349 271981 55 20 62 21 1 14 118 20 76 23 56 29 - - 132 25 250 231982 37 29 41 19 1 24 79 23 66 21 66 46 - - 132 33 211 291983 80 22 120 21 2 9 202 22 147 23 103 31 2 11 252 26 454 241984 93 20 115 19 3 20 211 19 140 22 77 24 2 8 219 22 430 211985 72 21 71 21 5 15 148 21 108 22 65 30 3 11 176 25 324 231986 97 19 114 21 3 16 214 20 136 20 69 31 2 13 207 24 421 221987 76 19 88 22 6 16 170 20 120 19 71 21 11 15 202 19 372 201988 59 17 76 19 12 10 147 17 110 18 71 24 11 16 192 20 339 191989 95 15 89 17 4 19 188 16 93 20 59 23 16 9 168 20 356 181990 78 15 107 15 14 11 199 15 104 20 66 27 9 11 179 22 378 181991 78 15 111 16 22 14 211 15 106 17 76 28 19 9 201 20 412 181992 74 16 113 18 16 8 203 16 94 19 67 27 17 8 178 21 381 181993 75 16 111 21 7 8 193 18 96 17 71 18 22 7 189 16 382 171994 84 15 94 16 16 10 194 15 93 16 66 22 16 9 175 17 369 161995 67 12 83 16 13 16 163 14 110 14 64 22 10 12 184 16 347 151996 83 15 101 14 7 16 191 15 114 13 66 23 16 8 196 15 387 151997 63 12 106 14 3 17 172 13 120 11 71 16 12 9 203 13 375 131998 87 14 107 14 8 12 202 14 109 13 64 21 10 4 183 15 385 141999 72 11 99 15 10 10 181 13 106 14 73 25 11 8 190 17 371 152000 61 14 69 17 5 10 135 15 81 15 60 33 11 10 152 21 287 182001 57 14 86 16 1 24 144 15 110 14 57 33 7 9 174 19 318 172002 57 14 80 16 8 15 145 16 115 11 53 28 11 8 179 15 324 152003 47 13 58 20 8 14 113 16 97 15 59 27 4 11 160 19 273 182004 47 13 52 16 2 9 101 15 74 14 30 28 5 13 109 18 210 162005 1 6 - - - - 1 6 3 8 2 11 - - 5 9 6 8

Table 38. Mean days hospitalized in the system’s acute care unit by year of injury and neurological leveland extent of injury. [day-1 admissions, using square-root transformation]


105

Level and Extent of InjuryYear Paraplegia Tetraplegia Total

of Incomplete Complete Minimal Total Incomplete Complete Minimal TotalInjury n Mean n Mean n Mean n Mean n Mean n Mean n Mean n Mean n Mean1973 11 76 16 88 - - 27 83 16 66 21 144 - - 37 107 64 961974 18 69 29 109 - - 47 92 21 112 29 161 - - 50 139 97 1151975 26 89 48 94 - - 74 92 47 107 40 164 - - 87 132 161 1131976 31 78 54 80 - - 85 79 52 96 43 165 - - 95 125 180 1021977 38 68 74 91 - - 112 83 54 102 52 136 - - 106 118 218 991978 33 52 52 75 - - 85 66 64 101 52 130 - - 116 114 201 921979 58 61 69 80 - - 127 71 78 106 51 143 - - 129 120 256 941980 66 72 84 91 - - 150 83 106 105 72 131 1 14 179 114 329 991981 54 71 62 68 1 6 117 69 75 83 54 145 - - 129 107 246 881982 34 57 42 72 1 11 77 64 61 97 58 118 - - 119 107 196 891983 73 66 118 71 2 29 193 69 142 90 95 124 2 59 239 103 432 871984 92 55 114 73 3 43 209 64 139 92 69 129 2 31 210 103 419 831985 70 54 68 73 5 25 143 61 103 90 58 91 3 48 164 90 307 761986 94 58 111 63 3 21 208 60 131 81 59 117 2 37 192 91 400 741987 75 72 87 66 5 32 167 67 116 79 62 131 10 38 188 92 355 801988 60 64 75 66 12 29 147 62 106 80 63 121 10 25 179 90 326 761989 95 49 88 68 3 59 186 58 90 79 51 113 16 22 157 82 343 681990 78 54 105 63 12 35 195 57 102 71 63 93 8 26 173 76 368 661991 74 47 111 62 21 28 206 52 97 83 66 107 18 42 181 86 387 671992 73 46 107 60 13 23 193 52 89 77 60 96 16 39 165 79 358 641993 74 42 109 48 7 37 190 45 92 68 59 91 22 27 173 69 363 561994 81 39 91 44 14 22 186 40 87 51 60 96 14 22 161 63 347 501995 64 35 82 43 13 18 159 37 104 58 59 78 10 22 173 62 332 491996 80 35 99 44 7 37 186 40 111 44 65 74 16 20 192 51 378 451997 60 33 104 43 3 15 167 39 116 49 71 68 12 30 199 54 366 471998 85 31 107 43 8 16 200 37 105 50 61 76 10 14 176 55 376 451999 72 36 98 36 10 24 180 35 105 50 70 74 11 14 186 56 366 452000 61 32 69 44 4 19 134 37 81 45 58 71 11 32 150 53 284 452001 57 30 81 38 1 24 139 35 104 51 48 64 6 17 158 53 297 442002 54 33 79 42 7 13 140 37 115 41 49 63 8 16 172 45 312 412003 47 31 52 46 7 36 106 38 94 42 56 68 2 25 152 51 258 452004 47 35 50 42 2 22 99 38 73 37 28 53 3 28 104 41 203 392005 1 22 - - - - 1 22 3 30 2 39 - - 5 33 6 31

Table 39. Mean days hospitalized in the system’s rehab unit by year of injury and neurological level andextent of injury. [day-1 admissions, using square-root transformation]


106

Figure 9. Mean days hospitalized in the system’s acute care unitby year of injury and neurologic level.

0

5

10

15

20

25

30

35

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

Year of Injury

Paraplegia Tetraplegia Paraplegia and Tetraplegia

Days


107

Figure 10. Mean days hospitalized in the system’s rehab unitby year of injury and neurologic level.

Days

0

20

40

60

80

100

120

140

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

Year of Injury

Paraplegia and Tetraplegia Paraplegia Tetraplegia


108

TOTAL SCI CARE SYSTEM HOSPITAL CHARGES

Table 40 (page 109) shows mean total system hospital charges by year of injury.

Only patients admitted to a system within one day of injury were used in this analysis.Therefore, Table 40 and Figure 11 (page 111) reflect hospital charges for patientstreated entirely within each respective SCI Care System. Only patients with actual orestimated charges (that do and do not include physicians’ fees) are included. Sincethere were very few patients with estimated charges, it is not likely that their inclusionwill alter the results appreciably. In addition, all system charges have been adjusted forinflation to 2004 dollars using the Medical Care Component of the Consumer PriceIndex. The distribution of system hospital charges, like that of days hospitalized, is notnormal and therefore, the square root transformation was used in this analysis as well.

In constant 2004 dollars, mean total system charges increased from $156,609 during1973 and 1974 to $246,469 in 1991 and 1992. This increase most likely reflects thetrend toward improved survival of more severely injured persons at the scene of theinjury who subsequently require greater intensity of service (such as mechanicalventilation) despite declining rehabilitation lengths of stay. Since 1992, mean totalsystem charges decreased to only $215,556 in 2002, but increased again to $282,245in 2003.

Future reports will examine trends separately for acute care and rehabilitation chargesas more data for individual treatment phases are submitted.


109

Year of Injury

1973-1974 1975-1976 1977-1978 1979-1980 1981-1982

n Mean n Mean n Mean n Mean n Mean

Total 137 156,609 319 185,762 400 182,670 520 203,918 365 222,438

Year of Injury

1983-1984 1985-1986 1987-1988 1989-1990 1991-1992


Total 651 225,949 527 197,609 507 210,203 581 224,625 537 246,469

Year of Injury

1993-1994 1995-1996 1997-1998 1999-2000 2001


Total 553 228,623 568 221,397 639 211,157 500 232,424 254 238,586

Year of Injury

2002 2003 2004 2005

n Mean n Mean n Mean n Mean

Total 288 215,556 227 282,245 159 291,971 5 162,198

Table 40. Total system hospital charges (2004 dollars) by year of injury.[day-1 admissions with actual or estimated charges only, square root transformation]


111

Figure 11. Mean total system hospital charges by injury yearand neurologic level

0

50

100

150

200

250

300

350

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

Paraplegia Tetraplegia Paraplegia and Tetraplegia

2004 Dollars(in thousands)

Year of Injury

[Day-1 admissions with actual or estimated charges only; using square root transformation]


112

SPONSORS OF CARE

Sponsors of care at admission and at post-injury years (extended data years only) forthe National SCI Database appear in Table 41 (page 113). Because many patients hadmore than one source of support, the percentages provided in these tables do not sumto 100.

Private Insurance ranked first during the period of initial hospitalization, providing atleast partial support for slightly less than half of the patients. Medicaid provided at leastpartial support for about one-fourth of the patients during this same period.

Private Insurance ranked first during the first and second post-injury years. Theproportion receiving Medicare benefits also increased substantially (from just 5.3percent in year 1 to 43.0 percent by year 30). The proportion receiving Medicaidsupport decreased steadily through all years post-injury.

Three relatively new sponsors of care categories have been established in recent years.These include the Indigent, Other Private Funds and Prepaid Health Plans categories.In past years these sponsors were included in the Other category.


113

n Initial Year Post-injurySponsor

% Hospitalization 1 2 5 10 15 20 25 30

Private 10,986 7,662 5,412 3,255 1,581 902 614 308 37

Insurance 46.4 37.8 36.1 29.8 29.2 29.2 28.3 26.3 30.6

DVR 2,015 2,220 1,774 632 129 49 13 3 1

8.5 11.0 11.8 5.8 2.4 1.6 0.6 0.3 0.8

Medicaid 6,832 6,468 4,589 3,002 1,321 644 375 157 1628.8 31.9 30.6 27.5 24.4 20.9 17.3 13.4 13.2

Workers’ 2,257 1,770 1,316 836 426 264 171 86 6Compensation 9.5 8.7 8.8 7.6 7.9 8.5 7.9 7.4 5.0

Medicare 1,452 1,066 1,039 3,303 1,962 1,196 857 414 526.1 5.3 6.9 30.2 36.2 38.7 39.5 35.4 43.0

County 124 96 71 33 18 8 16 1 0Medical 0.5 0.5 0.5 0.3 0.3 0.3 0.7 0.1 0.0

Self-pay 274 269 312 180 87 62 45 32 21.2 1.3 2.1 1.6 1.6 2.0 2.1 2.7 1.7

Veterans’ 44 146 129 115 46 23 36 34 6Administration 0.2 0.7 0.9 1.1 0.8 0.7 1.7 2.9 5.0

Public Health 92 110 120 82 48 28 8 7 0Service 0.4 0.5 0.8 0.7 0.9 0.9 0.4 0.6 0.0

Crippled 484 300 184 40 4 2 0 0 0

Childrens’ 2.0 1.5 1.2 0.4 0.1 0.1 0.0 0.0 0.0

Indigent 576 131 59 20 7 6 7 1 0

2.4 0.6 0.4 0.2 0.1 0.2 0.3 0.1 0.0

Other 609 456 337 166 53 23 15 8 1

Insurance 2.6 2.3 2.2 1.5 1.0 0.7 0.7 0.7 0.8

Other 25 26 14 17 14 10 10 8 0

Funds 0.1 0.1 0.1 0.2 0.3 0.3 0.5 0.7 0.0

Prepaid 1,544 898 387 375 229 217 210 112 17

Plans 6.5 4.4 2.6 3.4 4.2 7.0 9.7 9.6 14.0

Other 194 142 120 80 46 32 18 2 1

0.8 0.7 0.8 0.7 0.8 1.0 0.8 0.2 0.8

Table 41. Sponsors of care by time post-injury.


114

TYPE OF REIMBURSEMENT

The Type of Reimbursement variable is another item added to substantiate theeconomic reasons (i.e., medical insurance/coverage) for shorter lengths of stay. Onlyrecords entered after 1995 have been used in this analysis.

On Form I (Table 42, page 114) 8.8% of the new cases are coded unknown, 26.7% ofthe patients had limited per-diem coverage, 22.0% had fee for services coverage and16.6% had unlimited per-diem coverage. Unknown responses ranged from 0% to17.1%.

Data collection for this variable during follow-up was discontinued starting in 2000.

n Indigent Charges Fee for Per Diem Negotiated Capitated Other Unknown

% Service Unlimited Limited Fee

Total 337 699 1,420 1,073 1,720 699 293 173 566

5.2 10.8 22.0 16.6 26.7 10.8 4.5 2.7 8.8

Table 42. Type of reimubursement during the initial hospitalization period.


116

MEDICAL CASE MANAGER

Tables 43 and 44 document whether or not a medical case manager was assigned bythe primary sponsor of care during the initial inpatient hospitalization/rehabilitationphase and during follow-up.

During the initial hospitalization period (Table 43, page 116), 8.7% of the new recordswere coded unknown, 41.4% of the patients did not have a case manager and 7.1% ofthe records were coded “not applicable” (for the indigent patients). Unknown responsesranged from 0% to 12.4%.

During follow-up (table 44, page 116) most of the patients did not have a medical casemanager through all the post-injury years.

n Not

%No Yes

ApplicableUnknown Total

Total 2,671 2,760 456 561 6,448

41.4 42.8 7.1 8.7

Table 43. Medical case manager during the initial inpatient hospitalization/rehabilitation period.

Medical Case n Year Post-injuryManager? % 1 2 5 10 15 20 25 30

No 2,533 1,260 1,733 1,203 1,248 1,181 626 73

52.4 54.1 60.4 61.0 67.8 72.9 74.7 79.3

Yes 1,398 512 570 371 370 294 132 16

28.9 22.0 19.9 18.8 20.1 18.1 15.8 17.4

Not applicable 203 108 82 46 50 54 37 2

4.2 4.6 2.9 2.3 2.7 3.3 4.4 2.2

Unknown 696 451 482 353 174 92 43 1

14.4 19.3 16.8 17.9 9.4 5.7 5.1 1.1

Total 4,830 2,331 2,867 1,973 1,842 1,621 838 92

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 44. Medical case manager during follow-up.


119

COMPLICATIONS

Data on Complications have only been collected in the present form since October1986. Database revisions in 1995 deleted several complication variables and limitedthe documentation of complications during acute care to individuals who were admittedto the system within 24 hours of injury. Additionally, renal function is now documentedonly during the rehab phase for all patients.

The percentage of individuals developing each secondary medical complication duringacute care or rehabilitation by neurologic impairment category appears in Table 45(page 120). Only the records for the day-1 admissions have been used in this analysis.Overall, pneumonia was the most frequent secondary medical complication, occurring in34.0 percent of individuals. Pressure ulcers ranked second (33.6%), followed by deepvein thrombosis (15.0%) and pulmonary embolism (3.6%). Only 19.2 percent of theindividuals had none of the currently documented secondary medical complications.

Persons with neurologically complete tetraplegia were at highest risk for all secondarymedical complications except deep vein thrombosis and post-op wound infections. Infact, among persons with neurologically complete tetraplegia, 60.1% developedpneumonia; 53.2% developed pressure ulcers, 16.1% developed deep vein thrombosis,5.3% developed a pulmonary embolism and 2.3% developed a post-op wound infection.

The percentage of persons developing secondary medical complications during eachpost-injury year appears in Table 46 (page 120). Since the pressure ulcer complicationduring follow-up is collected at the time of the annual evaluation examination, onlypatients who had such an exam (in an extended-data year) were used in this analysis(n=16,404).

The most frequent complication was pressure ulcers observed during the annualevaluation examination, beginning at 14.9 percent in the first post-injury year andsteadily increasing thereafter. The next most common complication was pneumoniawhich ranged from 2.6 percent to 3.9 percent over time.

Because of the bias introduced by losses to follow-up that occur disproportionatelyamong healthier persons, the occurrence of the complications shown in Table 46 isprobably slightly overestimated. Therefore, caution is warranted when interpretingthese data.


120

n Paraplegia Tetraplegia TotalComplication% Incomplete Complete IncompleteComplete

Pneumonia 303 592 636 731 2,26220.2 34.2 28.8 60.1 34.0

Pressure ulcers 278 676 636 648 2,23818.5 39.0 28.8 53.2 33.6

Deep vein thrombosis 209 344 250 196 99913.9 19.8 11.3 16.1 15.0

Pulmonary Embolism 40 70 65 65 2402.7 4.0 2.9 5.3 3.6

Post-op Wound Infection 52 59 34 28 1733.5 3.4 1.5 2.3 2.6

Table 45. Number of patients developing secondary medical complications duringsystem by neurologic impairment for persons admitted to the systemwithin 24 hours of injury. [ n = 6,661; 19.2% had none of the listedmedical complications ]

Complication n Post-injury Year

% 1 2 5 10 15 20 25 30Pressure ulcers* 1,018 685 513 338 176 81 37 4

14.9 17.2 18.6 22.3 21.4 24.4 26.8 26.7

Pneumonia 385 269 185 96 65 60 31 3

3.8 3.9 3.1 2.6 2.6 3.5 3.7 3.3

Deep vein thrombosis 270 84 45 32 11 10 5 0

2.7 1.2 0.8 0.9 0.5 0.6 0.6 0.0

Pulmonary Embolism 66 17 15 9 5 5 1 0

0.7 0.2 0.3 0.3 0.2 0.3 0.1 0.0

Table 46. Percentage of patients developing secondary medical complicationsduring the post-injury years. [* among those who had annualexaminations]


121

PRESSURE ULCERS DURING REHAB

Table 47 (page 122) presents an analysis of the grade and anatomical location ofpressure ulcers developed during the rehabilitation phase of the initial hospitalizationperiod. This analysis used the records of patients whose Form I was entered into thedatabase on or after 2/1/96, and/or who were admitted directly to a system’s rehab unitand who developed a pressure ulcer during rehab (n= 2,510). Overall, 3,767 pressureulcers were reported.

Almost half of all reported ulcers were grade one; severe ulcers (grades three and four)accounted for only 9.3 percent. The grade of 11.4 percent of all pressure ulcers wasunknown, suggesting data collection difficulties. The most common pressure ulcerlocation was the sacrum, the site of one-third of all reported ulcers.


122

Anatomic n Grade Total

Location % 1 2 3 4 Unknown

Occiput 28 52 11 2 12 10526.7 49.5 10.5 1.9 11.4 2.8

Scapula 53 69 20 6 16 16432.3 42.1 12.2 3.7 9.8 4.4

Elbows 51 33 5 0 10 9951.5 33.3 5.1 0.0 10.1 2.6

Ribs 21 8 2 4 4 3953.8 20.5 5.1 10.3 10.3 1.0

Spinous process 24 28 7 4 5 6835.3 41.2 10.3 5.9 7.4 1.8

Iliac crest 24 22 5 0 7 5841.4 37.9 8.6 0.0 12.1 1.5

Sacrum 474 501 108 61 108 1,25237.9 40.0 8.6 4.9 8.6 33.2

Ischium 254 127 10 10 52 45356.1 28.0 2.2 2.2 11.5 12.0

Trochanter 63 26 5 4 18 11654.3 22.4 4.3 3.4 15.5 3.1

Genital 112 31 3 1 39 18660.2 16.7 1.6 0.5 21.0 4.9

Knee 35 18 6 1 5 6553.8 27.7 9.2 1.5 7.7 1.7

Malleolus 41 41 8 0 10 10041.0 41.0 8.0 0.0 10.0 2.7

Heel 329 208 40 7 69 65350.4 31.9 6.1 1.1 10.6 17.3

Feet 90 49 10 2 16 16753.9 29.3 6.0 1.2 9.6 4.4

Unclassified 94 79 5 4 60 24238.8 32.6 2.1 1.7 24.8 6.4

Total 1693 1292 245 106 431 3,76744.9 34.3 6.5 2.8 11.4 100.0

Table 47. Frequency of pressure ulcers developing during rehab by grade andanatomic location. [patients whose Form I was entered into the databaseon or after 2/1/96, and/or who were admitted directly to a system’s rehab unitand had pressure ulcers during rehab (n = 2,510)]


123

OPERATIVE PROCEDURES

Once again, the listing and definitions for operative procedures were revised in October1986. In November 1995 procedures that are performed almost exclusively duringfollow-up were deleted from Form I. All of the remaining procedures on Form I are nowcollected only on patients who are admitted to the system within 24 hours of injury.Operative procedures performed during system hospitalization appear in Table 48(page 124) and, only the records on the day-1 admissions were used.

Slightly more than half of the patients underwent a spinal fusion and almost half had aninternal fixation during system hospitalization. Other operations performed on morethan ten percent of the patients include traction, halo, spinal decompression,laminectomy and laparotomy. Less than 2 percent of the patients had any of the othercurrently documented operative procedures.

The percentage of operative procedures performed during each extended-data post-injury year appears in Table 49 (page 124). During each year most records indicatenone of the selected operative procedures were performed. Closure of pressure ulcerwas the procedure most often performed in all years except year 25 when calculusremoval ranked first. For all follow-up years except year 25 the second most commonprocedure was calculus removal.


124

YesOperative Procedure

n %

Spinal fusion* 3,802 54.5Internal fixation* 3,370 48.3Spinal decompression* 2,098 30.1Halo 2,042 29.3Traction 1,803 25.9Laminectomy* 1,122 16.1Laparotomy 705 10.1Closure of pressure ulcer 115 1.6Surgical repair of internal fixation* 94 1.3Surgical repair of failed spinal fusion* 63 0.9

Table 48. Frequency of selected operative proceduresperformed during system hospitalization. [ n = 6,973(34.4% had no OR visits for spinal surgeries*]

Operative Procedure n Year Post-injury% 1 2 5 10 15 20 25 30

Bladder neck resection 15 19 9 7 8 5 2 0

0.1 0.3 0.2 0.2 0.3 0.3 0.2 0.0

Calculus removal 212 209 122 107 68 31 29 0

2.1 3.0 2.0 2.9 2.7 1.8 3.5 0.0

Closure of pressure 281 249 218 169 120 69 23 3

ulcer 2.8 3.6 3.6 4.5 4.7 4.0 2.7 3.3

Sphincter dilatation/ 38 80 46 23 5 14 6 0

opening procedures 0.4 1.2 0.8 0.6 0.2 0.8 0.7 0.0

Table 49. Frequency of operative procedures performed during follow-up.


125

NEUROLOGIC LEVEL AND EXTENT OF LESION

Figure 12 (page 126) depicts the percent of patients by neurologic level of lesion atdischarge for the entire National SCI Database. Overall, 51.0 percent of patients hadcervical lesions at discharge, 34.3 percent had thoracic lesions, and 10.3 percent hadlumbo-sacral lesions. Approximately thirty-nine percent of the patients in the databasewere discharged with lesions at C4 (13.6%), C5 (14.9%) or C6 (10.9%). The next mostcommon level of lesion at discharge was T12 (6.7%). Neurologic level of lesion atdischarge is presented in Table 50 (page 127).

The neurologic impairment category (level and extent of lesion) at discharge is reflectedfor each system in Table 51 (page 127). Neurologically incomplete tetraplegia rankedfirst at time of discharge (29.7%), followed by neurologically complete paraplegia(26.0%), neurologically complete tetraplegia (20.7%) and neurologically incompleteparaplegia (18.5%).

Neurologic categories at discharge by grouped etiology are depicted in Figure 13 (page132). Neurologically incomplete tetraplegia ranked first for all etiologies except Acts ofViolence. Neurologically complete paraplegia ranked first for spinal cord injuriesresulting from Acts of Violence. Interestingly, 87.6 percent of all Sports Injuries resultedin tetraplegia, while 69.2 percent of all Acts of Violence resulted in paraplegia.

The percent of patients with neurologically incomplete lesions at discharge by year ofinjury is depicted in Figure 14 (page 133). The proportion of patients with neurologicallyincomplete lesions increased from 45.9 percent for 1973-79 to 55.3 percent for 2000-2005. This trend can be attributed at least in part to improved emergency medicalservices at the scene of the injury. However, despite the recent advent of high dosemethylprednisolone therapy, the percentage of persons with neurologically incompleteinjuries at discharge decreased from 1991 to 1994, most likely due to the proportionateincrease in SCIs that are secondary to gunshot wounds. SCIs due to gunshot woundsare usually neurologically complete. Since 1994, the percentage of incomplete injurieshas once again increased as the percentage of injuries due to acts of violence hasdeclined.


126

Figure 12. Percent of patients by neurologic level of lesion at discharge.

0

2

4

6

8

10

12

14

16

C01 C02 C03 C04 C05 C06 C07 C08 T01 T02 T03 T04 T05 T06 T07 T08 T09 T10 T11 T12 L01 L02 L03 L04 L05 S N

% Patients


127

n Level of Lesion

% C1 C2 C3 C4 C5 C6 C7 C8 Total CervicalLesions

Total 160 321 584 3211 3521 2577 1268 427 12,069

0.7 1.4 2.5 13.6 14.9 10.9 5.4 1.8 51.0

Table 50. Neurologic level of lesion at discharge – cervical lesions.

n Level of Lesion% T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 Total Thoracic

Lesions

Total 365 267 418 907 603 696 473 651 428 929 801 1,592 8,130

1.5 1.1 1.8 3.8 2.5 2.9 2.0 2.7 1.8 3.9 3.4 6.7 34.3

Table 50. Neurologic level of lesion at discharge – thoracic lesions.

n Level of Lesion

% L1 L2 L3 L4 L5 Total Lumbar Lesions

Total 1166 525 431 218 100 2,440

4.9 2.2 1.8 0.9 0.4 10.3

Table 50. Neurologic level of lesion at discharge– lumbar lesions.

n Level of Lesion Total

% S1 S2 S3 S4 S5 TotalSacral Normal Unknown All Lesions

Total 53 28 2 8 9 100 159 785 23,683

0.2 0.1 <0.1 <0.1 <0.1 0.4 0.7 3.3 100.0

Table 50. Neurologic level of lesion at discharge – sacral lesions, normal neurologic andunknown.

n Paraplegia Tetraplegia Total

% Incomplete Complete Minimal Total Incomplete Complete Minimal TotalNormal Unknown

Total 4,376 6,161 270 10,807 7,040 4,906 348 12,294 159 423 23,683

18.5 26.0 1.1 45.6 29.7 20.7 1.5 51.9 0.7 1.8 100.0

Table 51. Neurologic impairment category at discharge.


132

Figure 13. Neurologic category at discharge by grouped etiology.

PC (25.8%)

TC(21.8%)PI (17.1%)

TI (32.8%)

Other/Unknown (2.5%)

Vehicular Accidents

PC (5.2%)

TC (40.3%)

PI (5.8%)

TI (47.3%)


Sports Injuries

PC (43.2%)

TC (15.3%)PI (26.0%)

TI (14.0%)


Acts of Violence

PC (21.3%)

TC(15.5%)PI (22.2%)

TI (37.5%)


Falls


133

Figure 14. Neurologic extent of lesion at discharge by injury year.

0

20

40

60

80

100

1973-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2005

Incomplete Complete

%

Year of Injury


134

ASIA IMPAIR MENT SCALE

ASIA Impairment Scale by neurologic level of lesion at discharge appears in Table 52.The ASIA Impairment Scale, formerly referred to as the Frankel Grade, attempts toquantify the degree of residual neurologic function. Among persons with high cervical(C1-C4), low cervical (C5-C8) and thoracic lesions, neurologically complete lesionsranked first. [It should be noted that those patients coded "C99", "T99", "L99" and "S99"(specific level unknown) are included as "Unknowns" since exact level is required inTable 52.]

The change in ASIA Impairment Scale between admission to and discharge from thesystem appears in Table 53 (page 135) for only day-1 admissions. Of those patientsadmitted with neurologically complete lesions, 86.7 percent remained neurologicallycomplete at discharge, 11.3 percent improved neurologically; the remaining patientshad unknown ASIA Impairment Scales at discharge. Of the 14.7 percent of patientswho were admitted as Motor Nonfunctional, over half showed an improvement inneurologic function by discharge. Overall, 20.1 percent of patients in the database weredischarged with a higher degree of preserved neurologic function than when admitted,while only 1.4 percent were discharged with a lower degree of function.

ASIA Impairment n Cervical Thoracic Normal/

Scale % High Low High LowLumbar Sacral

MinimalUnknown Total

Complete 1,828 3,021 2,472 3,190 435 5 0 118 11,06942.8 38.8 75.9 65.4 17.8 5.0 0.0 15.0 46.7

Sensory only 397 1,152 259 368 239 5 0 17 2,4379.3 14.8 8.0 7.6 9.8 5.0 0.0 2.2 10.3

Motor 629 894 200 489 485 3 0 21 2,721Nonfunctional 14.7 11.5 6.1 10.0 19.9 3.0 0.0 2.7 11.5

Motor 1,385 2,656 314 800 1251 85 0 142 6,633Functional 32.4 34.1 9.6 16.4 51.3 85.0 0.0 18.1 28.0

Recovered 0 0 0 0 0 0 159 1 160

0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.1 0.7

Unknown 37 70 11 27 30 2 0 486 663

0.9 0.9 0.3 0.6 1.2 2.0 0.0 61.9 2.8

Total 4,276 7,793 3,256 4,874 2,440 100 159 785 23,683

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 52. ASIA Impairment Scale by neurologic level of lesion at discharge.


135

ASIA Impairment n Admission to During System DischargeScale % System Improved No Change Declined Unknown from System

Complete 5,017 569 4,349 0 99 4,604

48.3 11.3 86.7 0.0 2.0 44.3

Sensory Only 1,362 621 642 60 39 1,012

13.1 45.6 47.1 4.4 2.9 9.7

Motor 1,529 805 645 44 35 1,194

Nonfunctional 14.7 52.6 42.2 2.9 2.3 11.5

Motor Functional 1,869 91 1,683 40 55 3,085

18.0 4.9 90.0 2.1 2.9 29.7

Recovered 1 0 0 1 0 114

<0.1 0.0 0.0 100.0 0.0 1.1

Unknown 613 0 0 0 613 382

5.9 0.0 0.0 0.0 100.0 3.7

Total 10,391 2,086 7,319 145 841 10,391

100.0 20.1 70.4 1.4 8.1 100.0

Table 53. Change in degree of preserved neurologic function (ASIA Impairment Scale) betweenadmission to and discharge from the system. [day-1 admissions only]


136

ASIA MOTOR INDEX SCORE

The ASIA Motor Index Score is a measure of motor function ranging from 0 to 100 usedto document neurologic recovery. Mean ASIA Motor Index Scores at initial systemadmission, admission to rehab and at first definitive system discharge by system appearin Table 54 (page 136). The ASIA Motor Index Score was added to the database in1986 and data collection at admission to rehab was added in 1993. There are now3,419 patients with known scores at system admission, admission to rehab and atdischarge. The mean score increased from 41.9 at system admission to 44.6 at rehabadmission and to 51.9 at discharge. A similar trend was observed at all systems.

System Admission Rehab Admission Discharge

n Mean StandardDeviation

Mean StandardDeviation

Mean StandardDeviation

Total 3,419 41.9 24.7 44.6 25.1 51.9 26.7

Table 54. Mean ASIA Motor Index Scores at system admission, rehab admission anddischarge.


137

FUNCTIONAL INDEPENDENCE MEASURE

Functional status of patients at system discharge and gain in function from rehabilitationadmission to system discharge are important measures of the quality of care providedby Model Systems. The instrument chosen by the Model Systems to assess functionalstatus is the Functional Independence Measure (FIM) introduced in 1986 by the TaskForce to Develop a Uniform Data System (UDS) for Medical Rehabilitation. Althoughthe complete FIM consists of 18 items, only the motor items are currently documentedin the national SCI database. The total motor score is also documented with 13 unitsthe lowest possible score and 91 units the highest possible score (representing themost independent level of motor function). Items include feeding, grooming, bathing,dressing upper and lower body, toileting, bladder and bowel control, transfer to bed orchair, toilet, tub or shower, locomotion and stair climbing

Prior to inclusion in the national data base, a pilot study of interrater reliability of ModelSystem FIM data was conducted by Dr. Gale Whiteneck and co-workers at the RockyMountain Regional Spinal Cord Injury Care System. The results of the pilot study werepresented to the Project Directors who determined that the reliability of the FIM wassufficient to warrant inclusion in the database.


138

To date, complete FIM data at both rehabilitation admission and system discharge havebeen reported for 9,693 patients enrolled in the national SCI database. The analyticmethods used for this report are identical to those employed by the UDS to facilitatecomparison of UDS and Model System data. Because these analytic methods arecontroversial7,8,9,10,11,12,13 the results in this report should be interpreted cautiously.

Mean total motor FIM scores at rehabilitation admission and system discharge, as wellas mean total motor FIM score gains between rehabilitation admission and systemdischarge by neurologic level and extent of lesion appear in Table 55.

Mean rehabilitation lengths of stay and rehabilitation efficiency estimates (mean gainper day spent in rehabilitation) are also provided. Mean total motor FIM score atrehabilitation admission ranged from 36 units for persons with incomplete paraplegia to15 units for those with complete tetraplegia. Mean total motor FIM scores at systemdischarge ranged from 73 units to 30 units for the same neurologic categories. Meantotal motor FIM score gain was essentially the same for all persons (32-37 units) exceptfor those with complete tetraplegia who experienced an average gain of only 15 units.Length of stay efficiency estimates ranged from .87 units per day for persons withincomplete paraplegia to .17 units per day for those with complete tetraplegia.

Mean Motor FIM Mean Motor FIM Mean Rehab Efficiency

Level and Extent n RehabAdmission

RehabDischarge

Gain DuringRehab

Length ofStay

(Mean gainper day in

rehab)

Paraplegia,incomplete 2,014 36 73 37 42 0.87

Paraplegia, complete 2,653 31 67 36 52 0.69

Tetraplegia,incomplete 3,186 23 54 32 62 0.51

Tetraplegia, complete 1,840 15 30 15 88 0.17

Total 9,693 26 57 31 60 0.51

Table 55. Gain in the functional independence measure (FIM) motor score per day spent inrehabilitation by neurologic level and extent of injury at discharge.


139

RESPIRATOR USE

Respirator use by level and extent of injury and by System appears in Table 56 (page139). In October 2000, data collection of respirator use during system hospitalizationwas deleted and the data are now collected at the time of System rehab admission andat the time of first definitive discharge. Beginning with this report, only patients whowere admitted to System rehab are included in the Rehab Admit columns of Table 56and in the analyses for Figure 15.

Of the patients who were admitted to the System rehab, more than one-fifth of thepersons with tetraplegia required the use of a mechanical respirator at the time ofadmission to rehab. Six percent of these patients, however, were discharged on arespirator.

Intersystem variability in the proportion of persons with tetraplegia who required the useof a respirator at system rehab admit was substantial, ranging from 1.2 percent to 38.1percent. The proportion of those with tetraplegia who were discharged respiratordependent also varied considerably, ranging from 1.1 percent to 19.3 percent.

By comparison, 7.1 percent of persons with paraplegia required a respirator at the timeof rehab admission and less than one percent were discharged on a respirator.

The proportion of persons with paraplegia who required a respirator at system rehabadmission varied from 3.0 percent to 21.1 percent. By discharge however, there wasless intersystem variability; fewer than four percent of persons with paraplegia weredischarged respirator dependent at all systems.

Figure 15 (page 141) shows the proportion of patients who required the use of amechanical respirator at the time of admission to the System rehab unit by injury yearand neurologic level of lesion. The proportion of persons with tetraplegia who requiredthe use of a respirator increased from 13.9 percent prior to 1980 to 32.1 percentbetween 1990 and 1994. The proportion of persons with paraplegia who required theuse of a respirator increased to 11.6 between 1995 and 1999.

Tetraplegia Paraplegian Rehab Admit Discharge Rehab Admit Discharge

% n Yes Unknown n Yes Unknown n Yes Unknown n Yes Unknown

Total 11,806 2,503 895 12,294 749 77 10,594 748 766 10,807 75 32

21.2 7.6 6.1 0.6 7.1 7.2 0.7 0.3

Table 56. Respirator use at System rehab admission and at discharge for persons with tetraplegia andparaplegia.


141

Figure 15. Respirator use at System rehab admissionby injury year and neurologic level of lesion

Year of Injury

0

5

10

15

20

25

30

35

40

1973-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2005

Tetraplegia Paraplegia

% Respirator Use


142

BLADDER MANAGEMENT

Tables 57A and 57B (pages 143 and 144 respectively) present a cross-sectionalanalysis of method of bladder management for the entire National SCI Database, bygender. Only the most recent record for patients with known management was includedin this analysis and the results are presented for discharge and the extended datayears. Several new categories were added to this variable in 1996. Therefore, theabsence of data in those categories is not surprising and as a result, the tables must beinterpreted cautiously. The high percentage of unknowns at admission is attributed toanother 1996 change.

It is not surprising that the method most used during initial hospitalization for both malesand females was intermittent catheterization. Because of increasingly shortrehabilitation lengths of stay, many males have not yet completed the intermittentcatheterization program and graduated to the use of condom catheter drainage. Thistrend is reflected by the decline in intermittent catheterization at first annual withconcomitant increase in condom usage. The gradual decrease in normal micturitionover time results from these individuals being increasingly less likely to return for follow-up. The high percentages of individuals with suprapubic cystostomies after year 15 isthe result of the presence of a high proportion of records from one system in which thisis a very common method of management.


143

Method of Bladder n Year Post-injuryManagement %

Discharge1 2 5 10 15 20 25 30

None 191 117 36 55 31 17 13 7 01.8 3.6 2.3 2.9 2.5 1.7 1.4 1.2 0.0

Indwelling catheter 1,128 321 165 193 155 93 91 41 6alone 10.7 9.8 10.6 10.2 12.4 9.3 9.8 6.9 8.5Indwelling catheter 3 4 1 8 20 21 14 2 0after augmentation <0.1 0.1 0.1 0.4 1.6 2.1 1.5 0.3 0.0Catheter free with external 88 85 37 102 101 120 123 89 9collector;no sphincterotomy 0.8 2.6 2.4 5.4 8.1 12.0 13.2 15.0 12.7Catheter free with external 7 5 4 17 30 50 50 37 6collector;with sphincterotomy 0.1 0.2 0.3 0.9 2.4 5.0 5.4 6.2 8.5

Catheter free with external 1,334 312 282 230 146 61 14 11 2collector; sphincterotomy unknown 12.6 9.5 18.1 12.2 11.7 6.1 1.5 1.9 2.8Catheter free 252 88 31 45 20 14 15 12 2no external collector 2.4 2.7 2.0 2.4 1.6 1.4 1.6 2.0 2.8ICP only 1,844 717 237 495 284 191 128 68 6

17.4 21.9 15.2 26.2 22.8 19.1 13.7 11.4 8.5ICP with external collector 105 123 19 49 33 39 27 18 3

1.0 3.8 1.2 2.6 2.6 3.9 2.9 3.0 4.2ICP after augmentation 1 7 3 5 13 14 6 1 0

or continent diversion <0.1 0.2 0.2 0.3 1.0 1.4 0.6 0.2 0.0ICP unknown 3,123 287 190 104 64 39 10 0 1

29.5 8.8 12.2 5.5 5.1 3.9 1.1 0.0 1.4Conduit 5 2 3 8 13 9 8 19 2

<0.1 0.1 0.2 0.4 1.0 0.9 0.9 3.2 2.8Suprapubic Cystostomy 933 153 84 180 143 203 299 200 25

8.8 4.7 5.4 9.5 11.5 20.3 32.1 33.7 35.2Normal 1,519 1,047 459 388 183 126 125 79 7

14.4 32.0 29.4 20.5 14.7 12.6 13.4 13.3 9.9Other 42 8 11 11 12 5 9 10 2

0.4 0.2 0.7 0.6 1.0 0.5 1.0 1.7 2.8Total 10,575 3,276 1,562 1,890 1,248 1,002 932 594 71

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0Table 57A. Method of bladder management by time post-injury - males. [cross-sectional analysis]


144

Method of Bladder n Year Post-injuryManagement %

Discharge1 2 5 10 15 20 25 30

None 83 46 17 23 9 8 1 5 03.2 5.4 4.9 4.6 3.2 3.4 0.5 3.1 0.0

Indwelling catheter 727 157 98 119 67 63 58 49 6alone 28.0 18.3 28.1 23.8 24.0 26.7 29.0 30.8 31.6Indwelling catheter 1 2 0 3 4 6 0 1 0after augmentation <0.1 0.2 0.0 0.6 1.4 2.5 0.0 0.6 0.0Catheter free with external 0 0 0 0 0 0 0 0 0collector;no sphincterotomy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Catheter free with external 0 0 0 0 0 0 0 0 0collector;with sphincterotomy 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Catheter free with external 1 0 0 0 0 0 0 0 0collector; sphincterotomy unknown <0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Catheter free 84 21 7 21 6 3 7 3 3no external collector 3.2 2.5 2.0 4.2 2.2 1.3 3.5 1.9 15.8ICP only 447 198 40 119 85 64 61 51 2

17.2 23.1 11.5 23.8 30.5 27.1 30.5 32.1 10.5ICP with external collector 0 0 0 0 0 0 0 0 0

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0ICP after augmentation 0 3 1 6 6 7 4 1 1

or continent diversion 0.0 0.4 0.3 1.2 2.2 3.0 2.0 0.6 5.3ICP unknown 689 67 53 30 21 11 4 0 1

26.5 7.8 15.2 6.0 7.5 4.7 2.0 0.0 5.3Conduit 2 2 0 5 7 5 9 3 1

0.1 0.2 0.0 1.0 2.5 2.1 4.5 1.9 5.3Suprapubic Cystostomy 77 40 11 35 15 28 21 21 1

3.0 4.7 3.2 7.0 5.4 11.9 10.5 13.2 5.3Normal 485 316 119 136 56 36 34 22 1

18.7 36.9 34.1 27.2 20.1 15.3 17.0 13.8 5.3Other 2 4 3 3 3 5 1 3 3

0.1 0.5 0.9 0.6 1.1 2.1 0.5 1.9 15.8Total 2,598 856 349 500 279 236 200 159 19

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 57B. Method of bladder management by time post-injury - females. [cross-sectional analysis]


145

DAYS AND REASONS REHOSPITALIZED POST-DISCHARGE

Mean days rehospitalized during the extended data years for the entire National SCIDatabase appear in Table 58 (page 145). Only those patients who were rehospitalizedin the selected post-injury years are included in the "n's"; the percentages are calculatedusing the total number of patients followed in each given post-injury year.

For those patients rehospitalized, the average length of stay was relatively constantover time (26 days in the first post-injury year and 20 days in the 25th year). Morecomplete studies of rehospitalization frequency and risk factors may be found in thepublications titled Predicting Unplanned Hospitalizations in Persons with Spinal CordInjury, Archives of Physical Medicine and Rehabilitation, Vol. 75, November 1994,pages 1182-1188 and Etiology and Incidence of Rehospitalization After TraumaticSpinal Cord Injury: A Multicenter Analysis, Archives of Physical Medicine andRehabilitation, Vol. 85, November 2004, pages 1757-1773.

Table 59 (page 147) reflects reasons for rehospitalizations. This is a new variable thatwas added to the NSCISC database in 2000. Percentages do not add to 100 becausesome patients had more than 1 rehospitalization reason. All Form IIs for the requireddata submission years, entered since 2000, for those who were hospitalized, were usedin this analysis (n=1,808).

Diseases of the genitourinary system were the leading cause of rehospitalization duringall post-injury years except for year 30 where diseases of the skin was the mostcommon cause of rehospitalization. Circulatory, respiratory, digestive andmusculoskeletal diseases and conditions were also relatively common causes ofrehospitalization.

Relatively high percentages of “other unclassified” causes suggest that additionalcategories may need to be identified for this variable. Although there is a relatively highpercentage of unknowns, 75% of the records coded unknown were entered in 2000.Percentages of unknowns have decreased significantly (to 10% or less of the recordsentered after 2000).

Year 01 Year 02 Year 05 Year 10

n % Mean n % Mean n % Mean n % Mean

Total 5,410 31 26 4,212 33 27 2,172 24 23 948 22 24


n % Mean n % Mean n % Mean n % Mean

Total 516 20 22 356 21 22 187 22 20 23 25 14

Table 58. Percentages of patients rehospitalized and mean total days rehospitalized byyear post-injury.


147

n Year Post-InjuryReason% 1 2 5 10 15 20 25 30

Infectious Diseases 17 0 8 7 8 3 4 12.6 0.0 2.5 2.8 5.0 1.5 2.4 3.8

Cancer 3 0 1 2 1 3 3 10.5 0.0 0.3 0.8 0.6 1.5 1.8 3.8

Endocrine Diseases 6 0 3 1 0 1 4 00.9 0.0 0.9 0.4 0.0 0.5 2.4 0.0

Blood Diseases 13 0 8 5 3 1 6 22.0 0.0 2.5 2.0 1.9 0.5 3.6 7.7

Mental Disorders 15 0 3 3 6 0 1 02.3 0.0 0.9 1.2 3.8 0.0 0.6 0.0

Disease of the 21 0 8 4 1 5 5 0Nervous System 3.2 0.0 2.5 1.6 0.6 2.6 3.0 0.0

Diseases of the 49 4 26 13 16 10 10 0Circulatory System 7.5 9.1 8.2 5.2 10.1 5.1 6.0 0.0

Diseases of the 73 7 26 25 9 21 25 2Respiratory System 11.2 15.9 8.2 10.1 5.7 10.8 15.0 7.7

Disease of the 39 8 38 32 13 21 15 2Digestive System 6.0 18.2 11.9 12.9 8.2 10.8 9.0 7.7

Diseases of the 189 12 73 65 51 61 58 5Genitourinary System 29.0 27.3 23.0 26.2 32.1 31.3 34.7 19.2

Childbirth/ Pregnancy 3 0 6 4 1 1 1 00.5 0.0 1.9 1.6 0.6 0.5 0.6 0.0

Diseases of the skin 92 4 64 55 41 50 29 814.1 9.1 20.1 22.2 25.8 25.6 17.4 30.8

Diseases of the 71 0 30 19 15 14 13 2Musculoskeletal System 10.9 0.0 9.4 7.7 9.4 7.2 7.8 7.7

Congenital anomalies 2 0 0 0 0 1 4 00.3 0.0 0.0 0.0 0.0 0.5 2.4 0.0

Symptoms and 18 0 5 3 3 1 0 1Ill-defined Conditions 2.8 0.0 1.6 1.2 1.9 0.5 0.0 3.8Injuries and 29 0 13 10 8 13 9 3

Poisoning 4.5 0.0 4.1 4.0 5.0 6.7 5.4 11.5Inpatient Rehab 45 3 8 2 0 4 3 0Services Only 6.9 6.8 2.5 0.8 0.0 2.1 1.8 0.0

Other unclassified 92 14 39 35 29 26 6 114.1 31.8 12.3 14.1 18.2 13.3 3.6 3.8

Unknown 40 2 20 10 5 7 11 06.1 4.5 6.3 4.0 3.1 3.6 6.6 0.0

Total persons rehospitalized 817 54 379 295 210 243 207 28Table 59. Frequency and percentage of each cause of rehospitalization, by year post-injury.

(Form IIs entered since 2000)


148

NUMBER OF HOURS OF OUTPATIENT PHYSICAL AND/OR OCCUPATIONAL THERAPY,OUTPATIENT PSYCHOLOGICAL AND/OR VOCATIONAL COUNSELING

Tables 60 and 61 present analyses of variables that were added to the database inNovember 1995. Only records of patients who were admitted to the system afterDecember 1995 (n=4,173) were used in the analyses.

The trend in shorter lengths of stay during the inpatient rehabilitation phase hasnecessitated the addition of 2 new variables (Post-discharge Physical and/orOccupational Therapy and Post-discharge Psychological and/or VocationalCounseling). Combined with the acute and inpatient rehabilitation lengths of stay, thesevariables will more accurately document the total amount of time for the initialrehabilitation phase.

Table 60 (page 149) presents the number of hours of outpatient physical and/oroccupational therapy post-discharge to the first anniversary of injury. Nationally, 9.7%of the records were coded unknown. Unknowns ranged from 0% to 24.5%. Overall,65.4% of patients were reported to have had outpatient physical and/or occupationaltherapy between discharge and first anniversary of injury.

Similar results exist for the number of hours of outpatient psychological and/orvocational counseling received post-discharge to the first anniversary of injury (Table61, page 149). Nationally, 9.4% of the records were coded unknown. Unknownsranged from 0% to 15.5.

Overall, only 20.7% of patients were reported to have had outpatient psychologicaland/or vocational counseling between discharge and first anniversary of injury.

There has been a considerable decrease in the percentages of unknowns in thesevariables since the 1999 report. The data collectors have been reminded that these areitems to be updated on Form I at the time the patient’s year 1 Form II is entered.


149

n Yes%

No# hours known # hours unknown

Unknown Total

Total 1,042 2,252 474 405 4,17325.0 54.0 11.4 9.7

Table 60. Number of hours of outpatient physical and/or occupational therapy post-discharge to the first anniversary of injury.

n Yes%

No# hours known # hours unknown

Unknown Total

Total 2,918 648 215 392 4,173

69.9 15.5 5.2 9.4

Table 61. Number of hours of outpatient psychological and/or vocationalcounseling post-discharge to the first anniversary of injury.


151

INTERVIEW INFORMATION

The majority of the new variables added to the database in late 1995 and again in late2000 were "interview" variables. Of those items added in 1995, the FIM, Satisfactionwith Life Scale, Self-perceived Health Status and the CHART are still a part of thedatabase. Pain Interfering with Work and the question “Compared To 1 Year Ago, HowWould You Rate Your Health In General Now?” were added in 1998. New items addedin 2000 were the CHIEF (short form), the Patient Health Questionnaire (brief version),Drug and Alcohol Use, the CAGE, Severity of Pain and the Date of the Interview. Howthe interview was conducted has been in the database since 1996.

Table 62 (page 151) presents a system analysis of how interviews were conducted.Nationally, 12.4% of all interviews conducted in person and system percentages rangedfrom 1.2% to 95.2%. Of the 15,789 records in which interviews were conducted, 69.4%were done by phone with system percentages ranging from 4.8% to 93.4%. Just overeight percent of the interviews were done by mail with system percentages ranging fromzero at 2 systems to 29.5% at another. Nationally, 6.8% of all interviews used acombination of the methods (i.e., in-person, by phone and/or by mail) with systempercentages ranging from zero at 2 systems to 29.5% at another. The interview methodwas unknown for 3.1% for all the interviews conducted.

n In By By% Person Phone Mail

Combination Unknown Total

Total 1,958 10,953 1,325 1,066 487 15,789

12.4 69.4 8.4 6.8 3.1

Table 62. How the interview was conducted.


153

SELF-PERCEIVED HEALTH STATUS

This SF12 question was added to the national database in October 1995. This analysisexcludes records in which code “9” (unknown or subject is too young) is used. All otherSF12 items except the pain question were deleted from the database in October 2000.

n Year Post-injury

% 1 2 5 10 15 20 25 30Total

Excellent 503 248 410 249 287 248 132 11 2,08813.1 13.8 16.8 14.8 17.4 16.5 16.5 12.2 15.1

Very good 905 371 660 462 413 427 230 37 3,50523.6 20.7 27.0 27.4 25.1 28.5 28.7 41.1 25.4

Good 1,407 708 870 635 653 565 323 27 5,18836.7 39.5 35.6 37.6 39.6 37.7 40.3 30.0 37.6

Fair 741 370 395 265 236 209 100 14 2,33019.3 20.6 16.1 15.7 14.3 13.9 12.5 15.6 16.9

Poor 235 94 91 59 41 46 14 1 5816.1 5.2 3.7 3.5 2.5 3.1 1.7 1.1 4.2

Don’t know 9 0 5 3 0 0 0 0 17

0.2 0.0 0.2 0.2 0.0 0.0 0.0 0.0 0.1

Refuses 35 2 16 15 18 5 2 0 93

0.9 0.1 0.7 0.9 1.1 0.3 0.2 0.0 0.7

Total 3,835 1,793 2,447 1,688 1,648 1,500 801 90 13,802

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 63. Self-perceived health status by year post-injury.


154

HOW WOULD YOU RATE YOUR HEALTH

Compared to 1 year ago, how would you rate your health in general now? is a relatedSF12 variable that was added to the database with the SF12 items in May 1998.

n Year Post-injury% 1 2 5 10 15 20 25 30

Total

Much better 1,195 253 228 109 113 94 82 11 2,08541.5 24.8 13.2 8.9 9.3 7.9 10.3 12.2 20.6

Somewhat 699 304 336 176 138 136 94 12 1,895better 24.3 29.7 19.4 14.4 11.4 11.4 11.8 13.3 18.7About the same 524 347 940 737 769 746 478 51 4,592

18.2 34.0 54.3 60.4 63.3 62.6 59.9 56.7 45.3Somewhat 240 94 169 145 150 172 125 15 1,110worse 8.3 9.2 9.8 11.9 12.3 14.4 15.7 16.7 10.9Much worse 170 19 39 36 27 34 15 1 341

5.9 1.9 2.3 3.0 2.2 2.9 1.9 1.1 3.4Don’t know 6 1 3 1 0 1 0 0 12

0.2 0.1 0.2 0.1 0.0 0.1 0.0 0.0 0.1Refuses 43 4 16 16 18 8 4 0 109

1.5 0.4 0.9 1.3 1.5 0.7 0.5 0.0 1.1Total 2,877 1,022 1,731 1,220 1,215 1,191 798 90 10,144

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 64. Compared to one year ago, how would you rate your health in general now?


155

SATISFACTION WITH LIFE SCALE TOTAL SCORE

In 1995 several new variables were added during the extended data follow-up years todocument psycho/social outcomes. Table 65 (page 155) is an analysis of the TotalScore for the Satisfaction with Life Scale. Only records newly entered into the databaseafter 1995, for patients whose current age was 18 or older, were used in this analysis.Of the 17,578 records available for this analysis, the total score is known for 76% of allrecords. Overall, mean life satisfaction total score ranged from 18 at post-injury years 1and 2 to 23 at post-injury year 25 (excluding year 30).

Year Post-injuryYear 01 Year 02 Year 05 Year 10


Total 3,733 18 1,742 18 2,358 20 1,643 20



Total 1,600 22 1,453 22 797 23 89 24

Table 65. Satisfaction with life - total score by year post-injury.


157

THE CHART

The CHART (Craig Handicap Assessment and Reporting Technique) was added to thenational database in 1996. It is administered in the extended data follow-up years(currently years 1, 5, 10, 15, 20, 25, and 30) to individuals whose current age is 18years or older. From 1996 to October 2000, the version of the CHART that was used inthe database consisted of 26 questions and 5 subscales (physical independence,mobility, occupational status, social integration, and economic self-sufficiency). In 2000,the version of the CHART that is included in the database was changed to the shortform of the CHART that consists of only 20 questions and includes a sixth subscale(cognitive independence). The CHART data collected from 1996 through 2000 wereconverted to the short form of the CHART by the NSCISC so that all CHART data in thedatabase are currently in the same format. Each subscale score is capped at 100, andscores of less than 100 imply the presence of a handicap. For the economic subscale,scores of 100 imply the individual is living at twice the poverty level, while a score of 50would imply the individual is living at the poverty level.

Table 66 (page 157) depicts the mean CHART physical independence score by yearpost-injury for each model system. The mean physical independence score increasesover time from 70 in the first post-injury year to 89 in post-injury year 30. However,there is considerable intersystem variability in physical independence scores. Forexample, in the first post-injury year, mean physical independence scores range from50 in one system to 89 in another. This intersystem variability will require furtherinvestigation as it is unlikely to result simply from differences in patient populationsbeing served by each model system.

Year Post-injury



Total 3,956 70 1,888 72 2,490 77 1,721 77

Year Post-injury



Total 1,677 81 1,516 85 808 85 91 89

Table 66. CHART – physical independence subscale score by year post-injury.


159

Table 67 depicts the mean CHART cognitive independence subscale score by yearpost-injury for each model system. The mean cognitive independence score increasesover time from 83 in the first post-injury year to 97 in post-injury year 25. Once again,there is considerable intersystem variability in these scores. In the first post-injury year,mean cognitive independence scores range from 56 to 97. Therefore, furtherinvestigation of this variability will be undertaken.

Year Post-injury



Total 1,879 83 123 83 1,097 89 807 90

Year Post-injury



Total 616 93 776 94 644 95 91 97

Table 67. CHART – cognitive independence subscale score by year post-injury.


160

Table 68 depicts the mean CHART mobility subscale score by year post-injury for eachmodel system. The mean mobility score increases over time from 74 in the first post-injury year to 82 in year 30. There is less intersystem variability in mean mobility scoresthan physical and cognitive independence scores. In the first post-injury year, meanmobility scores range from 63 to 79.

Year Post-injury



Total 3,940 74 1,891 76 2,481 79 1,711 81

Year Post-injury



Total 1,673 82 1515 82 797 82 91 82

Table 68. CHART mobility subscale score by year post-injury.


161

Table 69 depicts the mean CHART occupational status subscale score by post-injuryyear for each model system. The mean occupational status score increases from 48 inthe first post-injury year to 69 in post-injury year 30. Although the occupational statussubscale includes other activities besides competitive employment, the trend over timein this subscale score is consistent with many previous studies of return to work afterspinal cord injury that have shown a gradual increase in the employment rate over time.Mean occupational status subscale scores in the first post-injury year range from 32 to61.

Year Post-injury



Total 3,862 48 1,852 50 2,433 59 1,701 62

Year Post-injury



Total 1,643 64 1,500 68 794 70 90 69

Table 69. CHART occupational status subscale score by year post-injury.


162

Table 70 depicts the mean CHART social integration subscale score by post-injury yearfor each model system. Overall, the mean social integration score increases only veryslightly over time from 87 in the first post-injury year to 89 by post-injury year 20. Meansocial integration scores in the first post-injury year range from 75 to 93 i.

Year Post-injury



Total 3,824 87 1,812 85 2,409 86 1,699 88

Year Post-injury



Total 1,656 88 1,497 89 787 89 90 89

Table 70. CHART social integration subscale score by year post-injury.


163

Table 71 depicts the mean CHART economic self-sufficiency subscale score by post-injury year for each model system. Once again, the mean economic self-sufficiencyscore increases over time, ranging from 67 in post-injury year 2 to 83 in post-injury year30. Intersystem variability in mean economic self-sufficiency scores at the firstanniversary of injury is substantial, ranging from a mean score of 53 to 79. Althoughthis variability may genuinely reflect differences in the patient populations served ateach model system, further investigation seems warranted.

Year Post-injury



Total 2,381 68 1,044 67 1,607 68 1,248 73

Year Post-injury



Total 1,299 77 1,218 78 680 81 78 83

Table 71. CHART economic self-sufficiency subscale score by year post-injury.


164

Table 72 (page 164) depicts the total CHART score for persons with complete data onall 20 CHART questions. Sample sizes of persons with complete data are relatively lowprimarily because of missing data in the economic self-sufficiency questions and thedelayed entry of the cognitive subscale into the database. The maximum total CHARTscore that can be achieved is 600. Overall, mean total CHART score increases from439 in post-injury year 2 to 528 in post-injury year 30. Mean total CHART scores in thefirst post-injury year range from 394 in Pittsburgh to 497 in Colorado.

Increases in mean CHART scores over time must be interpreted cautiously. This is across-sectional analysis and the patients in post-injury year 30 are not the same asthose in the first post-injury year.

Part of the increase in scores over time is likely due to differential survival of personswith higher initial CHART scores (for example, those who require less attendant care).Moreover, the model system with the highest overall mean total CHART scores(Colorado) contributes a much higher share of the data in post-injury years 20 through30 than in the first post-injury year. A truly accurate assessment of changes in CHARTscores over time will require a multivariate analysis with repeated measures of CHARTon the same individuals.

Year Post-injury



Total 1,261 446 80 439 782 476 585 486

Year Post-injury



Total 490 499 608 507 522 511 22 528

Table 72. CHART total score by year post-injury.


166

THE CHIEF

The CHIEF (Craig Hospital Inventory of Environmental Factors) was added to thenational database in October 2000. It is administered in the extended data follow-upyears (currently years 1, 5, 10, 15, 20, 25, and 30) to individuals whose current age is18 years or older. The CHIEF consists of 12 questions and 5 subscales (policies,physical/structural independence, work/school, attitudes/support, andservices/assistance) as well as a total score. Each question contains two parts, onethat reflects the frequency of a problem and the other that reflects the magnitude of theproblem when it occurs. Lower scores imply patients are encountering fewerenvironmental barriers.

Table 73 depicts the mean CHIEF policies subscale score by post-injury year andmodel system. Overall, the mean policies score is relatively constant over time, rangingfrom 0.6 in post-injury years 5, 20, 25 and 30 to 0.9 in post-injury year 2. During the firstpost-injury year, mean policies score ranges from 0.4 to 1.3.


167

Year Post-injury



Total 1,802 0.8 105 0.9 1,063 0.6 769 0.7

Year Post-injury



Total 598 0.7 756 0.6 635 0.6 89 0.6

Table 73. CHIEF policies subscale score by year post-injury.


168

Table 74 depicts the mean CHIEF physical/structural independence subscale score bypost-injury year and model system. Overall, the mean physical/structural independencescore decreases over time from 1.7 in post-injury year 2 to 0.9 in post-injury years 20,25 and 30. During the first post-injury year, mean physical/structural independencescore ranges from 0.6 to 2.1.

Year Post-injury



Total 1,811 1.4 106 1.7 1,061 1.2 783 1.2

Year Post-injury



Total 597 1.1 757 0.9 633 0.9 90 0.9

Table 74. CHIEF physical/structural subscale score by year post-injury.


169

Table 75 depicts the mean CHIEF work/school subscale score by post-injury year andmodel system. These scores are typically quite low in all follow-up years, ranging from0.2 to 0.4. Intersystem variability on this subscale is minimal. Sample sizes for thissubscale are lower than for other CHIEF subscales because only persons who are inschool or who are employed are asked to respond to these questions.

Year Post-injury



Total 492 0.3 31 0.4 397 0.3 309 0.4

Year Post-injury



Total 237 0.3 324 0.2 247 0.2 36 0.2

Table 75. CHIEF work/school subscale score by year post-injury.


170

Table 76 depicts the mean CHIEF attitudes/support subscale score by post-injury yearand model system. These scores range from 0.3 in post-injury year 30 to 0.8 in post-injury year 2. There does not appear to be substantial intersystem variability for thisCHIEF subscale.

Year Post-injury



Total 1,798 0.6 106 0.8 1,067 0.6 775 0.6

Year Post-injury



Total 600 0.6 761 0.5 634 0.4 89 0.3

Table 76. CHIEF attitudes/support subscale score by year post-injury.


171

Table 77 depicts the mean CHIEF services/assistance subscale score by post-injuryyear and model system. Overall, the mean services/assistance score decreases overtime from 1.2 in the second post-injury year to 0.6 in post-injury years 20, 25 and 30.Moderate intersystem variability exists for this subscale, with first post-injury year meanscores ranging from 0.6 to 1.5.

Year Post-injury



Total 1,795 1.0 105 1.2 1,059 0.8 776 0.8

Year Post-injury



Total 598 0.7 753 0.6 627 0.6 89 0.6

Table 77. CHIEF services/assistance subscale score by year post-injury.


172

Table 78 depicts the mean total CHIEF score by post-injury year and model system.The total CHIEF score is calculated as the mean score for each of the 12 questions thatcomprise the CHIEF. If the person is not employed or in school, then the total CHIEFscore is calculated as the mean of the remaining 10 questions included in the CHIEF.Overall, the mean total CHIEF score decreases slightly over time from 1.1 in post-injuryyear 2 to 0.5 in post-injury year 30. The mean total CHIEF score in the first post-injuryyear ranges from 0.5 to 1.5. Once again, any trends in CHIEF scores over time must beinterpreted carefully because of the same biases and limitations of cross-sectionalanalyses that were described previously concerning the analyses of CHART scoresover time (page 164).

Year Post-injury



Total 1,764 0.9 101 1.1 1,045 0.8 752 0.8

Year Post-injury



Total 584 0.7 738 0.6 613 0.6 87 0.5

Table 78. CHIEF total score by year post-injury.


174

PATIENT HEALTH QUESTIONNAIRE

The section on depression of the brief version of the Patient Health Questionnaire(PHQ) was added to the NSCISC database in October 2000. The PHQ consists of 9questions reflecting the frequency of problems associated with possible depression ofpersons plus a tenth question reflecting the overall level of difficulty caused by theseproblems. Each of the nine questions is scored from 0 (no problem) to 3 (nearly everyday). Major depressive syndrome is defined as scoring a 2 or 3 on at least one of thefirst two questions and scoring at least a 2 on a total of at least 5 of the nine questions.Other depressive syndrome is defined as scoring a 2 or 3 on at least one of the first twoquestions and scoring a 2 or 3 on between two and four of the nine questions. Also aseverity of depression score is calculated as the sum of the scores from the nine PHQquestions.

Table 79 depicts the frequency and percentage of persons with major and otherdepressive syndrome by post-injury year. The percentage of persons with majordepressive syndrome ranges from 12.5 in post-injury year 2 to 2.2 in post-injury year 30.The percentage of persons with other depressive syndrome ranges from 13.5 in post-injury year 2 to 6.9 in post-injury year 15. The percentage of persons with nodepressive syndrome ranges from 74.0 in post-injury year 2 to 90.0 in post-injury year30.

n Year Post-injury

% 1 2 5 10 15 20 25 30

No 1,380 77 867 647 507 659 555 81

77.3 74.0 81.9 83.1 85.1 87.1 87.0 90.0

Yes, major 198 13 101 67 48 42 33 2

11.1 12.5 9.5 8.6 8.1 5.5 5.2 2.2

Yes, other 208 14 90 65 41 56 50 7

11.6 13.5 8.5 8.3 6.9 7.4 7.8 7.8

Total 1,786 104 1,058 779 596 757 638 90

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 79. Major depressive syndrome during follow-up.


175

Table 80 depicts the mean depression severity score by time post-injury. This year’sanalysis excludes records in which the score is zero. Overall, mean depression severityscores decreased slightly over time, ranging from 7.1 in post-injury years 1 and 2 to 5.5in post-injury year 25. Once again, this trend must be interpreted cautiously because ofthe limitations of cross-sectional analyses and biases discussed previously (page 164).



Total 1,313 7.1 82 7.1 730 6.5 530 6.3

Year Post-injury



Total 375 6.2 476 5.6 393 5.5 54 6.3

Table 80. Severity of depression score by year post-injury.


176

ILLEGAL DRUG USE

Frequency of the use of illegal drugs or the use of prescribed medications fornonmedical reasons by post-injury year is depicted in Table 81. This variable wasadded to the NSCISC database in October 2000. In this table, a person will be countedfor each drug that he/she reports using during the follow-up period. Therefore, thesame person may be counted multiple times. Overall, reported drug use was relativelyinfrequent, and was greatest for marijuana, followed by cocaine. However, this is a self-report variable, and some persons may be hesitant to admit use of illegal drugs.

n Year Post-injury

% 1 2 5 10 15 20 25 30

Cocaine 31 1 21 16 7 9 4 0

1.7 0.9 2.0 2.0 1.2 1.2 0.6 0.0

Pot/ 127 12 109 83 52 74 58 5

Marijuana 6.9 10.8 10.2 10.5 8.6 9.7 9.1 5.6

Hallucinogens 1 0 2 2 2 1 1 0

0.1 0.0 0.2 0.3 0.3 0.1 0.2 0.0

Heroin/opiates 3 0 3 4 0 1 1 0

0.2 0.0 0.3 0.5 0.0 0.1 0.2 0.0

Speed/ 3 0 3 6 2 1 5 0

Stimulants 0.2 0.0 0.3 0.8 0.3 0.1 0.8 0.0

Medications 10 3 15 10 7 10 9 0

(your own) 0.5 2.7 1.4 1.3 1.2 1.3 1.4 0.0

Medications 9 0 6 4 3 1 2 0

(not your own) 0.5 0.0 0.6 0.5 0.5 0.1 0.3 0.0

Undisclosed 6 1 3 5 6 9 2 0

Type 0.3 0.9 0.3 0.6 1.0 1.2 0.3 0.0

Table 81. Drug use by year post-injury


177

ALCOHOL USE

Alcohol use during the follow-up period is depicted in Tables 82 through 86 (pages 177to 180). Once again, these variables were added to the NSCISC database in October2000. The percentage of persons who reported drinking any alcoholic beverage eithercurrently or in the past ranges from 47.7 in post-injury year 2 to 75.6 in post-injury year30 (Table 82). Most persons who were drinkers reported alcohol use only one or twodays per week throughout all follow-up years (Table 83).

Alcohol n Year Post-injuryUse % 1 2 5 10 15 20 25 30No 899 58 417 314 223 202 175 22

48.7 52.3 38.9 39.5 36.7 26.3 27.2 24.4Yes 947 53 655 481 385 566 468 68

51.3 47.7 61.1 60.5 63.3 73.7 72.8 75.6

Total 1,846 111 1,072 795 608 768 643 90100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 82. Alcohol use during follow-up: Do you drink any alcoholic beverages?

Number of n Year Post-injuryDays % 1 2 5 10 15 20 25 30None 271 13 197 130 106 235 212 38

28.8 24.5 30.4 27.4 27.7 41.8 45.3 56.7One 287 20 171 141 90 113 68 7

30.5 37.7 26.3 29.7 23.6 20.1 14.5 10.4Two 153 10 121 75 67 87 66 5

16.2 18.9 18.6 15.8 17.5 15.5 14.1 7.5Three 68 2 56 28 43 39 35 5

7.2 3.8 8.6 5.9 11.3 6.9 7.5 7.5Four 39 1 25 25 21 17 16 1

4.1 1.9 3.9 5.3 5.5 3.0 3.4 1.5Five 28 1 28 12 10 15 17 5

3.0 1.9 4.3 2.5 2.6 2.7 3.6 7.5Six 19 2 10 7 4 6 11 1

2.0 3.8 1.5 1.5 1.0 1.1 2.4 1.5Seven 36 2 23 29 26 45 36 5

3.8 3.8 3.5 6.1 6.8 8.0 7.7 7.5Unknown 41 2 18 27 15 5 7 0

4.4 3.8 2.8 5.7 3.9 0.9 1.5 0.0

Total 942 53 649 474 382 562 468 67100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 83.Alcohol use: During the past month, how many days per week did you drinkany alcoholic beverages?


178

Table 84 reflects the cumulative frequency distribution for the number of days during thepast month that an individual reports having had a drink (among those who reportedalcohol use). Most persons indicated either that they had not had any drinks during thepast month (but had been drinkers previously) or had only one or two drinks per day onthe days that they did drink alcohol. A few persons reported consuming very largequantities of alcohol on those occasions when they drank.

Number of Drinks n % Cumulative %

0 882 24.5 24.5

1 835 23.2 47.7

2 821 22.8 70.6

3 402 11.2 81.7

4 210 5.8 87.6

5 95 2.6 90.2

6 142 3.9 94.2

7 25 0.7 94.9

8 27 0.8 95.6

9 8 0.2 95.8

10 25 0.7 96.5

11 2 0.1 96.6

12 29 0.8 97.4

15 3 0.1 97.5

16 1 <0.1 97.5

18 1 <0.1 97.5

20 4 0.1 97.6

24 1 <0.1 97.7

30 1 <0.1 97.7

40 1 <0.1 97.7

Number unknown 82 2.3 100.0

Table 84.Alcohol use: On the days you drank (during the pastmonth), about how may drinks did you drink?


179

Table 85 reflects the cumulative frequency distribution of how many times during thepast month the person had 5 or more drinks on an occasion. Approximately threequarters of persons did not report any occasion of having at least 5 drinks. However,approximately 5 percent reported having more than 5 drinks on 8 or more occasionsduring the past month.

Number ofOccasions

n % Cumulative %

0 2,724 75.7 75.7

1 258 7.2 82.9

2 147 4.1 87.0

3 81 2.3 89.2

4 118 3.3 92.5

5 45 1.3 93.7

6 17 0.5 94.2

7 8 0.2 94.4

8 29 0.8 95.2

9 5 0.1 95.4

10 21 0.6 96.0

11 1 <0.1 96.0

12 18 0.5 96.5

13 3 0.1 96.6

14 1 <0.1 96.6

15 4 0.1 96.7

16 10 0.3 97.0

20 11 0.3 97.3

24 1 <0.1 97.3

25 1 <0.1 97.3

28 2 0.1 97.4

30 13 0.4 97.8

31 11 0.3 98.1

Number unknown 69 1.9 100.0

Table 85. Alcohol use: How many times during the past month didyou have 5 or more drinks?


180

Table 86 depicts mean total CAGE score by post-injury year and model system. Notrend over time was observed, with mean total CAGE score at 0.4 in all post-injury yearsexcept post-injury years 1, 2, and 30. Although sample sizes were small (becausenondrinkers are not asked to respond to the CAGE), slight intersystem variability wasreported, with mean total CAGE score during the first post-injury year ranging from <0.1to 1.0.



Total 942 0.3 53 0.8 651 0.4 476 0.4

Year Post-injury



Total 385 0.4 563 0.4 468 0.4 68 0.2

Table 86. CAGE total score by time post-injury.


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PAIN

The severity of pain score is measured on a 0 to 10 scale. Table 87 depicts the meanpain score by post-injury year and model system for those who had a score from 1 to10. This variable was added to the NSCISC database in October 2000. Mean painseverity score did not vary meaningfully over time, ranging from 4.8 in post-injury year25 to 5.4 in post injury year 2. There was also not much intersystem variability in thereporting of pain severity scores.

Year Post-injury

Year 01 Year 02 Year 05 Year 10n Mean n Mean n Mean n Mean

Total 1,500 5.1 84 5.4 858 5.3 627 5.2

Year Post-injury

Year 15 Year 20 Year 25 Year 30n Mean n Mean n Mean n Mean

Total 499 5.0 635 4.9 520 4.8 80 5.3

Table 87. Severity of pain score by time post-injury.


182

Table 88 reflects responses to the question of the degree to which pain interfered withwork outside the home or housework. This is a variable from the SF-12 that was addedto the NSCISC database in May 1998. It was retained in the NSCISC database alongwith the self-reported rating of overall health when the remainder of the SF-12 wasdropped from the database in September 2000.

Overall, most persons who reported that they had pain also reported that the pain eitherdid not interfere with work or that it interfered only a little bit. However, a significantpercentage of persons reported moderate or more pain interference with work during allpost-injury years. The trend over time from post-injury year 1 to post-injury year 25 istoward slightly less pain interference with work.

n Year Post-injury% 1 2 5 10 15 20 25 30

Not at all 700 322 482 370 455 446 299 30

28.0 32.4 32.1 35.9 41.6 42.4 43.8 37.5

A little bit 679 218 381 257 236 239 147 1827.1 22.0 25.4 25.0 21.6 22.7 21.5 22.5

Moderately 431 179 245 143 172 171 114 17

17.2 18.0 16.3 13.9 15.7 16.3 16.7 21.3

Quite a bit 420 173 226 161 149 124 83 1116.8 17.4 15.1 15.6 13.6 11.8 12.2 13.8

Extremely 234 95 152 85 65 63 39 4

9.3 9.6 10.1 8.3 5.9 6.0 5.7 5.0

Don’t know 7 2 1 0 0 3 0 00.3 0.2 0.1 0.0 0.0 0.3 0.0 0.0

Refused 32 4 13 14 17 5 1 0

1.3 0.4 0.9 1.4 1.6 0.5 0.1 0.0

Total 2,503 993 1,500 1,030 1,094 1,051 683 80100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Table 88. Pain interfering with work by year post-injury.


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1. Smart, C.N. and Sanders, C.R. (1976) The Costs of Motor Vehicle Related SpinalCord Injuries. Insurance Institute for Highway Safety, Washington, D.C.

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6. Fine, P.R., Kuhlemeier, K.V., DeVivo, M.J. and Stover, S.L. (1979) Spinal cordinjury: an epidemiologic perspective. Paraplegia 17, 237-250.

7. Gresham, G.E. (1989) More research needed. Arch. Phys. Med. Rehabil. 70, 867.

8. Hamilton, B.B. and Granger, C.V. (1989) Totaled functional score can be valid.Arch. Phys. Med. Rehabil. 70, 861-862.

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2005 NSCISC Annual Statistical Report for the Mode · Downey, CA Northern California SCI System -...

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