Acute Traumatic Spinal Cord Injury Surveillance --
United States, 1987
In 1987, the Council of State and Territorial Epidemiologists
(CSTE) recommended designating traumatic spinal cord injuries
(SCIs)
as the first injury condition reportable to state health agencies
and
to CDC. In that same year, two surveys were conducted to identify
existing registries for SCIs in the United States. One survey,
which
was conducted by the Spinal Cord Injury Program in Florida, used a
computer- based information exchange system to gather information
from
vocational rehabilitation agencies. Agencies in 82% (42 of 51) of
the
states and the District of Columbia replied. The second, a
telephone
survey, was conducted independently by the National Spinal Cord
Injury
Association (NSCIA).* State health departments in all 50 states**
were
contacted.
Each survey identified eight states as having SCI registries;
however, the results of the surveys differed. These results and
information obtained by personal communication indicate that the
following 14 states have registries for traumatic SCI: Alabama,
Arkansas, Colorado, Florida, Georgia, Iowa, Louisiana, Maryland,
Missouri, Oklahoma, New Jersey, North Dakota, Virginia, and West
Virginia. In ten states, reporting is mandated by law; it is
voluntary
in the remaining four states. In most states, SCI data are
collected
to aid in planning for rehabilitative services.
Reported by: the Spinal Cord Injury Program, Div of Vocational
Rehabilitation, Dept of Labor and Employment Security,
Tallahassee,
Florida. J Spack, JD, National Spinal Cord Injury Assoc, Woburn,
Massachusetts. GR Istre, MD, State Epidemiologist, Oklahoma State
Dept
of Health. Div of Injury Epidemiology and Control, Center for
Environmental Health and Injury Control, CDC.
Editorial Note: CSTE's recommendation to designate SCIs as
reportable was based on the magnitude of the morbidity and
mortality
due to traumatic SCIs, the cost associated with these injuries,
and
the potential for their prevention. It is a practical choice
because
the number of cases is manageable and consensus can be reached on
the
case definition.
Estimates of the incidence of acute traumatic SCI in the
United
States range between 28 and 50 injuries per million persons per
year
(1). At present, there are over 200,000 cases of SCI in the United
States (2). Older adolescent and young adult males are at high
risk
for SCI. The consequences of injury for persons in these age
groups
include reduced lifetime employment, limited productivity, and
decreased quality of life. Injured individuals may also need
special
services throughout life (1). The direct medical costs of these
injuries to the federal government exceed $4 billion per year (3).
Lost earnings associated with SCI are estimated to be $3.4 billion
(in
1987 dollars) annually (Department of Rehabilitation Medicine,
University of Alabama/ Birmingham, unpublished data).
Surveillance is needed to better define the national incidence
of
acute traumatic SCI, to identify high-risk groups in order to
target
prevention strategies, and to determine etiologies so that
prevention
programs can be developed. The data presently collected by SCI
registries may be useful in targeting high-risk groups and
determining
etiologies. However, case definitions, reporting sources, and
level of
information collected vary among registries.
CDC is working with CSTE and other interested groups to 1)
review
existing surveillance systems and registries for acute traumatic
SCI,
2) determine the information needs of public health and clinical
practice, 3) develop a workable case definition, 4) determine the
information to be collected, and 5) identify reporting sources.
SCI is
one of the disabilities targeted for support by CDC's disabilities
prevention program. This program will provide state and local
agencies
with funding to prevent primary and secondary disabilities such as
those caused by acute traumatic SCIs.
The public health benefit of registries at the local level can
be
realized only if the information collected is useful to those
planning
intervention strategies. The implementation of these strategies
may
involve the participation of many agencies within the state or
local
government, along with private interest groups. Registries will be
useful at the national level only if a standard case definition is
used and if information is collected, analyzed, and interpreted
consistently and systematically.
References
Kraus JF. Epidemiological aspects of acute spinal cord injury:
a
review of incidence, prevalence, causes, and outcome. In:
Becker
DP, Povlishock JT, eds. Central nervous system trauma status
report--1985. Bethesda, Maryland: National Institute of
Neurological and Communicative Disorders and Stroke, National
Institutes of Health, 1985:313-22.
DeVivo MJ, Fine PR, Maetz HM, Stover SL. Prevalence of spinal
cord
injury: a reestimation employing life table techniques. Arch
Neurol 1980;37:707-8.
Ergas Z. Spinal cord injury in the United States: a
statistical
update. Cent Nerv Syst Trauma 1985;2:31-2.
*NSCIA is a private, nonprofit national health agency that serves
as a
resource and clearinghouse for information on SCIs, including
prevention and rehabilitation.
**The District of Columbia was not contacted.
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