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      Epidemiology of Traumatic Spinal Cord Injury in Developing Countries: A Systematic Review

      systematic-review

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          Abstract

          Background/Aims: To describe the epidemiology of spinal cord injury (SCI) in the developing world. Methods: Developing countries were selected based on the definition proposed by the International Monetary Fund. A literature search was performed in July 2012 in Medline and Embase. Further article procurement was obtained via the reference lists of the identified articles, websites, and direct contact with the authors of the identified studies. We designed search strategies using the key words: SCI, epidemiology, incidence, and prevalence. According to the inclusion criteria, 64 studies from 28 countries were included. Results: The incidence of SCI in developing countries is 25.5/million/year (95% CI: 21.7-29.4/million/year) and ranges from 2.1 to 130.7/million/year. Males comprised 82.8% (95% CI: 80.3-85.2) of all SCIs with a mean age of 32.4 years (95% CI: 29.7-35.2). The two leading causes of SCI were found to be motor vehicle crashes (41.4%; 95% CI: 35.4-47.4) and falls (34.9%; 95% CI: 26.7-43.1). Complete SCIs were found to be more common than incomplete injuries (complete SCI: 56.5%; 95% CI: 47.6-65.3; incomplete SCI: 43.0%; 95% CI: 34.1-52.0). Similarly, paraplegia was found to be more common than tetraplegia (paraplegia: 58.7%; 95% CI: 51.5-66.0; tetraplegia: 40.6%; 95% CI: 33.3-48.0). Conclusion: Through an understanding of the epidemiology of SCI in developing countries, appropriate preventative strategies and resource allocation may decrease the incidence and improve the care of these injuries.

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          Most cited references46

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          Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?

          Literature survey. To provide an overview of the literature data on incidence, prevalence and epidemiology of spinal cord injury (SCI) worldwide and to study their evolution since 1977. University Antwerp. The literature from 1995 onwards was searched on Pubmed. To include evolutionary data, we incorporated the results of three older studies. Two studies gave prevalence of SCI, and 17 incidence of SCI. The published data on prevalence of SCI was insufficient to consider the range of 223-755 per million inhabitants to be representative for a worldwide estimate. Reported incidence of SCI lies between 10.4 and 83 per million inhabitants per year. One-third of patients with SCI are reported to be tetraplegic and 50% of patients with SCI to have a complete lesion. The mean age of patients sustaining their injury at is reported as 33 years old, and the sex distribution (men/women) as 3.8/1. There is a need for improved registration of SCI, and publication of the findings in many parts of the world. This survey pleads for uniformity in methodology. The data show that the reported incidence and prevalence have not changed substantially over the past 30 years. Data from Northern America and Europe show higher figures for incidence, but prevalence figures have remained the same. Epidemiology of SCI seems to have changed during the last decades with a higher percentage of tetraplegia and of complete lesions. If such evolution is present worldwide, how it could eventually be prevented needs to be studied. Not applicable.
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            Incidence of Spinal Cord Injury Worldwide: A Systematic Review

            Background: Incidence studies of spinal cord injury (SCI) are important for health-care planning and epidemiological research. This review gives a quantitative update on SCI epidemiology worldwide through a statistical evaluation of incidence rates. Methods: A systematic review was conducted. For each study, the crude rate ratio was calculated and, when possible, age- and gender-adjusted incidence rate ratios with 95% CI were determined by direct adjustment or using Poisson regression. Results: Thirteen studies were included. Annual crude incidence rates in traumatic SCI varied from 12.1 per million in The Netherlands to 57.8 per million in Portugal. Compared to the Portuguese reference study, incidence rates showed a 3-fold variation, with the highest rates in Canada and Portugal. Most traumatic SCI studies showed a bimodal age distribution. The first peak was found in young adults between 15 and 29 years and a second peak in older adults (mostly ≧65 years). Motor vehicle accidents and falls were the most prevalent causes of injury accounting for nearly equal percentages. In contrast, another age pattern in non-traumatic SCI reflected steadily increasing incidence with advancing age. Conclusions: The results show significant variation in SCI incidence with changing epidemiological patterns. A trend towards increased incidence in the elderly was observed, likely due to falls and non-traumatic injury.
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              International Spinal Cord Injury Core Data Set.

              Survey of expert opinion, feedback, and development of final consensus. Present the background, purpose, development process, and results for the International Spinal Cord Injury (SCI) Core Data Set. International. A committee of experts was established to select and define data elements to be included in an International SCI Core Data Set. A draft core data set was developed and disseminated to appropriate organisations for comment. All suggested revisions were considered, and a final version of the core data set was disseminated again for approval and adoption. The core data set consists of 24 variables, including basic demographic characteristics, dates of admission and discharge from initial acute and rehabilitation care, cause of injury, place of discharge, presence of vertebral fractures and associated injuries, occurrence of spinal surgery, and measures of neurological and ventilator status. Collection of the core data set should be a basic ingredient of all future studies of SCI to facilitate accurate description of patient populations and comparison of results across published studies from around the world.
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                Author and article information

                Journal
                NED
                Neuroepidemiology
                10.1159/issn.0251-5350
                Neuroepidemiology
                S. Karger AG
                0251-5350
                1423-0208
                2013
                August 2013
                13 June 2013
                : 41
                : 2
                : 65-85
                Affiliations
                aSina Trauma and Surgery Research Center, Department of Neurosurgery, Shariati Hospital, and bStudent Scientific Research Center, Faculty of Medicine, Tehran University of Medical Sciences, cResearch Centre for Neural Repair, University of Tehran, and dDepartment of Community Medicine, School of Medicine, Tehran University of Medical Sciences and Health Services, Tehran, and eResearch Center for Pharmaceutical Nanotechnology and Iranian Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; fDepartment of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pa., USA
                Author notes
                *Vafa Rahimi-Movaghar, MD, Research Deputy, Sina Trauma and Surgery Research Center, Sina Hospital, Hassan-Abad Square, Imam Khomeini Avenue, Tehran University of Medical Sciences, Tehran 11365-3876 (Iran), E-Mail v_rahimi@sina.tums.ac.ir
                Article
                350710 Neuroepidemiology 2013;41:65-85
                10.1159/000350710
                23774577
                f959c9bb-7987-4a16-8f46-c6fbdaf64265
                © 2013 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 15 October 2012
                : 11 March 2013
                Page count
                Figures: 8, Tables: 2, Pages: 21
                Categories
                Systematic Review

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Spinal cord injury,Developing countries,Etiology ,Incidence,Epidemiology

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