Incidence
During the 4-year period, 491 individuals were admitted with TSCI. Almost half of the individuals came from Cali (49.29%). The mean annual incidence of TSCI for all the cases admitted to the referral center was 56.27 per million. For individuals only from Cali, the rate was 27.78 per million inhabitants. Figure 1 describes the temporal trend of cases over time by injury type.
TSCI persons’ characteristics
Mean age was 33±15 years (range 2-76), and 85.95% were male, for a male:female ratio of 6:1. Persons that were single and without insurance were younger compared to those married and with insurance (married vs. single, mean difference=9.15, 95%CI=6.33-11.99, p<0.0001; insured vs. without insurance, mean difference=3.90, 95%CI=1.02-6.78, p=0.008). It was found that 75.56% had an occupation before the injury and only 18.94% reported one after the injury, thus experiencing a 74.93% reduction in employment (p=0.006).
Based on the trauma mechanism, 47.45% of the TSCIs were caused by intentional injuries and 52.55% were caused by unintentional injuries. Falls were the most common cause of unintentional injuries (33.60%), followed by RTI (16.29%), and diving injuries (2.24%). Amongst intentional injuries, 99.57% (n=232) were caused by interpersonal violence and 0.43% (n=1) was caused by self-inflicted injuries.
Only 5.09% of the participants were older than 60 years old. TSCIs caused by violence were significantly higher in the ≤60 years old group (49.23% vs. 4.00%, p<0.0001), while falls caused a significantly higher proportion of TSCI in the >60 group (31.21% vs. 76.00%, p<0.0001).
The years with lowest and highest proportion of TSCI were 2012 (21.18%) and 2009 (24.86%), respectively. When comparing causes of TSCI over the years, we found a significant decrease in RTIs (β=-0.46, 95%CI=-0.73;-0.20, p=0.001, R2=2.45%) and an increase in violence (β=0.20, 95%CI=0.007;0.40, p=0.042, R2=0.85%) (Figure 1). We did not observe a change in either the age of the individuals over time (ANOVA, F=0.76, p=0.52) or when analyzing by subgroups of injury mechanism. The description of the injuries by mechanism is described in Table 1.
Most of the persons went directly to the referral center (80.45%) and only 1.83% of the individuals were seen in a different institution. Once in the hospital, 32.18% were seen by the Physical Medicine and Rehabilitation Department. Additional rehabilitation services were provided in the hospital to 49.49% of the individuals, including physical therapy (41.14%), respiratory therapy (36.05%), occupational therapy (14.66%), and phonoaudiology (2.85%). During hospitalization, 27.29% of the individuals developed complications; 11.20% developed pressure ulcers, 11% urinary infections, 10.39% neuropathic pain, 1.22% autonomic dysreflexia, and 1.02% developed deformities.
Follow-up with physical medicine within the same institution was provided to 41.75% of the individuals; 18.05% of these individuals were seen within the next 30 days, 34.15% within the next three months, 29.76% within the next 6 months, and 16.59% after more than 6 months. The median number of appointments for follow-up with the clinic of TSCI was 1 (interquartile range: 0-2).
TSCI by the mechanism of Injury
Table 2 describes the individuals’ characteristics based on the type of injury and Figure 3 describes the percentage of injuries by mechanism, sex, and age groups.
Unintentional injuries: Road traffic injuries
RTI occurrence was associated with weekend days (Friday to Sunday inclusive, 65% vs. 35%, p=0.03) and no other injury type was found related to the days of the week. Most of the individuals with a TSCI caused by a RTI were male, with a male:female ratio of 4:1, and 30% of the individuals were between 18 and 25 years of age.
Falls
Individuals with TSCI due to falls had a mean age of 42±16 years, most of them were male with a male:female ratio of 4:1, and 26.06% had ages between 46 to 55 years. Only two thirds of these individuals had healthcare insurance.
Intentional injuries: Interpersonal violence
Individuals with TSCI due to violence were the second youngest group with 40.52% in the age group of 18 to 25 years, with a male:female ratio of 9:1. In this subgroup the AIS grade was A in 53.02% of the individuals and the most common cause was a gunshot (98.37%), causing 100% of these injuries at the cervical and lumbar level, and 97.65% in the thoracic level. Individuals were injured mostly by a gunshot (90.52%) followed in a smaller proportion by a knife (8.62%), or other weapons (0.86%).
Individuals injured by a gunshot were younger (knife: n=20, mean=30±11, gunshot: n=210, mean=25±9, others: n=2, mean=50±31, Kruskal-Wallis p=0.01), had more traumatic brain injuries (knife 14.29%, gunshot 71.43%, others 14.29%, p=0.04), and the AIS grade A was more common when compared with individuals injured with other types of weapons (A 98.37%, B 85%, C 46.15%, D 61.54%, E 86.67%; p<0.05).
AIS at last follow-up
Comparing AIS grade at admission vs. last follow-up we found that the correlation between both variables was 96.52% (p<0.0001). AIS grades B and C were the classifications with higher changes in AIS grade from admission to last follow-up, with 57.58% (19) and 71.05% (27) of the individuals classified that way in admission remaining the same at the last follow-up, respectively. When individuals were admitted with an AIS grade B injury, they had at their last visit either AIS grade A or D in 15.15% (5) both, and when individuals were admitted with an AIS grade C, 28.95% (11) were AIS grade D at their last follow-up (See Figure 2). AIS grade A was also correlated with a higher rate of complications. AIS grade A had 53.59% of post-injury complications, whilst E had 4.19% of complications (p<0.0001).