A total of 1858 cases were identified; the median age was 38 (IQR = 27–49) years old; and the median rehabilitation LOS was 117 (IQR = 55–239) days.
Participant Characteristics: Fall Vs Nonfall Etiologies
Table 1 summarizes the demographic, injury, and medical characteristics patients with fall-induced SCI (41.7%, 775/1858) compared with patients with nonfall-induced SCI (58.3%, 1083/1858). Specifically, motor vehicle collisions represented 31.3%; struck by object, 13.9%; work-related, 5.8%; sports related, 4.0%; assault, 1.3%; and others, 1.7%. Generally, patients with fall-induced SCI (40 years old, IQR = 28 − 51) were older than those with nonfall-induced SCI (37 years old, IQR = 26 − 47) (P < 0.001).
Table 1
Characteristics of participants resulted from fall and non-fall (N = 1858)
Characteristics | Non-fall group | Fall group | P value |
n = 1083 (%) | n = 775 (%) |
Age (years) | | | χ2 = 26.009, P < 0.001 |
0–15 | 93 (8.6%) | 31 (4.0%) | |
16–30 | 303 (28.0%) | 204 (26.3%) | |
31–45 | 367 (33.9%) | 246 (31.7%) | |
46–60 | 267 (24.6%) | 236 (30.5%) | |
61 and above | 53 (4.9%) | 58 (7.5%) | |
Sex | | | χ2 = 11.502, P = 0.001 |
Male | 819 (75.6%) | 637 (82.2%) | |
Female | 264 (24.4%) | 138 (17.8%) | |
Level of injury | | | χ2 = 2.130, P = 0.144 |
Tetraplegia | 460 (42.5%) | 303 (39.1%) | |
Paraplegia | 623 (57.5%) | 472 (60.9%) | |
Severity of the injury | | | χ2 = 2.975, P = 0.085 |
Incomplete | 529 (48.8%) | 410 (52.9%) | |
Complete | 554 (51.2%) | 365 (47.1%) | |
Complication | | | χ2 = 0.850, P = 0.357 |
Yes | 720 (66.5%) | 531 (68.5%) | |
No | 363 (33.5%) | 244 (31.5%) | |
Rehabilitation LOS (IQR) | 126 (58, 268) | 100 (50, 194) | P < 0.001* |
* Mann-Whitney U test; IQR, interquartile range; LOS, length of stay |
Statistically significant differences were found between patients with fall- and nonfall-induced SCI with regard to age range, gender, rehabilitation LOS rather than level of injury, severity, and complications (Table 1). Patients with fall-induced SCI tended to be older were usually male (43.8% male vs 34.3% female).
Participant Characteristics: Low Fall Vs High Fall Etiologies
Falls from buildings were the most common cause of fall-induced SCI (22.7%), followed by scaffolding (16.8%), and slipping, tripping, and stumbling at the same height (15.0%). Other falls from height accounted for 23.1%, but the specific situation was not clear.
Table 2 summarizes the demographic, injury, and medical characteristics of patients with fall-induced SCI. Specifically, 212 cases (27.4%) were the result of a low fall and 563 cases (72.6%) were the result of a high fall. Patients with low fall-induced SCI were older than those with high fall-induced SCI [52 (IQR = 37.25-60) years old vs 37 (IQR = 27.00–46) years old, respectively P < 0.001]. Patients were transferred to rehabilitation hospitals 47 (IQR = 24–124) days after injury.
Table 2
Characteristics of participants resulted from low-fall and high-fall (N = 775)
Characteristics | Low fall group | High fall group | P value |
n = 212 (%) | n = 563 (%) |
Age (years) | | | χ2 = 166.975, P < 0.001 |
0–15 | 17 (8.0%) | 14 (2.5%) | |
16–30 | 22 (10.4%) | 182 (32.3%) | |
31–45 | 36 (17.0%) | 210 (37.3%) | |
46–60 | 88 (41.5%) | 148 (26.3%) | |
61 and above | 49 (23.1%) | 9 (1.6%) | |
Sex | | | χ2 = 2.332, P = 0.127 |
Male | 167 (78.8%) | 470 (83.5%) | |
Female | 45 (21.2%) | 93 (16.5%) | |
Level of injury | | | χ2 = 134.059, P < 0.001 |
Tetraplegia | 153 (72.2%) | 150 (26.6%) | |
Paraplegia | 59 (27.8%) | 413 (73.4%) | |
AIS grade | | | χ2 = 103.288, P < 0.001# |
A | 49 (23.1%) | 316 (56.1%) | |
B | 31 (14.6%) | 108 (19.2%) | |
C | 53 (25.0%) | 67 (11.9%) | |
D | 79 (37.3%) | 69 (12.3%) | |
E | 0 (0.0%) | 3 (0.5%) | |
Cases with spine surgery | 186 (87.7%) | 555 (98.6%) | χ2 = 43.168, P < 0.001 |
Vertebrae fracture or dislocation | | | χ2 = 275.529, P < 0.001 |
Yes | 92 (43.4%) | 538 (95.6%) | |
No | 120 (56.60%) | 25 (4.40%) | |
Major vertebrae fracture or dislocation | | | χ2 = 49.240, P < 0.001# |
C1-C2 | 3 (3.2%) | 1 (0.2%) | |
C3-C7 | 50 (53.8%) | 124 (23.0%) | |
T1-T4 | 0 (0.0%) | 10 (1.9%) | |
T5-T9 | 11 (11.8%) | 52 (9.7%) | |
T10-L2 | 28 (30.1%) | 330 (61.3%) | |
L3-L5 | 1 (1.1%) | 21 (3.9%) | |
Complication | | | χ2 = 0.422, P = 0.516 |
Yes | 149 (70.3%) | 382 (67.9%) | |
No | 63 (29.7%) | 181 (32.1%) | |
Other combined injuries | | | |
Extremity bones fracture | 11 (5.2%) | 131 (23.3%) | χ2 = 33.638, P < 0.001 |
Craniocerebral injury | 38 (17.9%) | 129 (22.9%) | χ2 = 2.267, P = 0.132 |
Thoracic injury | 6 (2.8%) | 111 (19.7%) | χ2 = 34.258, P < 0.001 |
Abdominal injury | 1 (0.5%) | 28 (5.0%) | χ2 = 8.665, P = 0.003 |
Pelvis fracture | 0 (0.0%) | 27 (4.8%) | χ2 = 10.534, P = 0.001 |
≥ 1 extraspinal lesions | 50 (23.6%) | 300 (53.3%) | χ2 = 54.857, P < 0.001 |
≥ 2 extraspinal lesions | 6 (2.8%) | 101 (17.9%) | χ2 = 29.545, P < 0.001 |
Median time from injury to rehabilitation (IQR) | 41 (21, 110.5) | 50 (25,126) | P = 0.043* |
Rehabilitation LOS | 78.5 (33, 150.25) | 112 (58, 215) | P < 0.001* |
* Mann-Whitney U test; # Fisher’s Exact Test; AIS, American Spinal Injury Association Impairment Scale; IQR, interquartile range; LOS, length of stay. |
Patients with low fall-induced SCI were more likely to suffer from tetraplegia (72.2%) and have incomplete injuries (76.9%). In contrast, patients with high fall-induced SCI were more likely to suffer from paraplegia (73.4%) and have complete injuries (56.1%).
A total of 630 patients had vertebral fractures and dislocations, accounting for 81.3% of all cases. Patients with high fall-induced SCI were more likely to have either vertebral fractures or dislocations (95.6% vs 43.4%, P < 0.001) that were mainly located at the thoracolumbar vertebral level (T10–L2, 61.3%). Among the 145 SCI cases without vertebral fractures, 82.6% were the result from a low fall. Overall, 48 cases were without fractures or dislocations, 51 had cervical spinal stenosis, and 36 had cervical disc herniation or clamping.
During the rehabilitation hospitalization, 531 patients (68.5%) suffered from complications, and no difference between patients with fall- or nonfall-induced SCIs was found. However, whether SCI was induced by a high fall or a low fall, were all prone to complications, such as intestinal dysfunction, urinary tract infection, neuropathic pain, and respiratory infection.
Patients with high fall-induced SCI had a higher risk of combined injuries than patients low fall-induced SCI (53.3% vs 23.6%; χ2 = 54.857, P < 0.001), and the same were in extremity bones fracture, thoracic injury, abdominal injury, and pelvis fracture. Craniocerebral injury was common in patients with low fall-induced SCI, accounting for 17.9% of low-fall cases.
Different neurological level of injury characteristics: low fall vs high fall etiologies
As shown in the Fig. 1, there were two peaks in patients with fall-induced SCI, including at the cervical (C4–T1, 31.5%) and lower thoracic (T9–T12, 32.9%) spinal cord. Patients with low fall-induced SCI were more likely to have cervical level-related SCI, especially at C4 (34.4%). Patients with high fall-induced SCI were likely to have lower thoracic level-related SCI (T9–T12, 40.1%); however, injury at the C4 levels was also common (11.2%).
Occupation Characteristics: Low Fall Vs High Fall Etiologies
A total of 657 patients had specific occupations before injury, accounting for 84.8% of total SCI cases (173 low fall-induced SCI and 484 were high fall-induced SIC). The proportion of manual laborers and subsistence farmers with SCI caused by a high fall was considerably higher than that caused by a low fall (37.4% vs 17.9% and 22.7% vs 8.7%, respectfully). The total proportion of patients with low fall- and high fall induced SCI that identified as ‘retired’ represented 22.5% and 1.4%, respectfully, of total cases. Details are shown in the Table 3.
Table 3
Proportion of patients with different occupations (N = 657)
Occupations | Low fall group | High fall group | Total |
n = 173 (%) | n = 484 (%) | N = 657 (%) |
Manual laborers | 31 (17.9%) | 181 (37.4%) | 212 (32.3%) |
Subsistence farmers | 15 (8.7%) | 110 (22.7%) | 125 (19.0%) |
Unemployed | 38 (22.0%) | 78 (16.1%) | 116 (17.7%) |
Retired | 39 (22.5%) | 7 (1.4%) | 46 (7.0%) |
Students | 7 (4.0%) | 34 (7.0%) | 41 (6.2%) |
Staff | 17 (9.8%) | 23 (4.8%) | 40 (6.1%) |
Freelancers | 11 (6.4%) | 14 (2.9%) | 25 (3.8%) |
Civil servants | 8 (4.6%) | 7 (1.4%) | 15 (2.3%) |
Professional skill workers | 4 (2.3%) | 9 (1.9%) | 13 (2.0%) |
Active duty soldiers | 0 (0.0%) | 11 (2.3%) | 11 (1.7%) |
Self-employed | 2 (1.2%) | 8 (1.7%) | 10 (1.5%) |
Enterprise administrators | 1 (0.6%) | 2 (0.4%) | 3 (0.5%) |