title: Epidemiology of severe cervical spinal trauma in the north area of São Paulo City: a 10-year prospective study. Clinical article.
abstract: OBJECTIVE
  The main objective was to study the epidemiological data obtained in patients with cervical spinal trauma (CST) in the north area of São Paulo City between 1997 and 2006.
  
  
  METHODS
  All patients with severe CST in the north area of São Paulo City were studied. The data analyzed were age, sex, incidence, causes of trauma, level of trauma, morbidity, deaths, and complications. Analytical tests were performed to study risks of trauma and complications. The chi-square and analysis of variance tests were used for analytical data (significance level p < 0.05).
  
  
  RESULTS
  The study population consisted of 217 patients who were hospitalized for CST. The average incidence rate was 21.6 cases annually or 1.8 cases monthly. The mean patient age was 36.75 years. The 20-40-year-old age bracket was found to be most highly represented, corresponding to 52.6% of total patients. Patients were predominantly male; 191 patients (88.01%) were male compared with only 26 female patients (11.99%). The ratio of men to women was 7.35:1. Injuries in the craniocervical region corresponded to 43 (19.8%) of the cases; injuries in the cervical subaxial region corresponded to 174 (80.2%) of the cases and were associated with worse neurological lesions. Additionally, 40.6% of patients presented with complications in other organs and systems; several patients presented with multiple complications, and 33 patients (15.02%) died. During the hospitalization period, 4 patients presenting as Grade A on the American Spinal Injury Association (ASIA) Scale evolved to Grade C, 1 patient presenting as ASIA Grade A evolved to Grade B, and 2 patients evolved to Grade E. Two patients who had been admitted without neurological lesions evolved to ASIA Grade C (1 patient postsurgery and 1 patient post-traction). Two patients presenting initially as ASIA Grade E evolved to Grade D, and another to central cord syndrome. On average, patients with incomplete lesions improved 1 grade in ASIA classification during hospitalization.
  
  
  CONCLUSIONS
  Data from severe CST observed in the current study suggest many differences in the characteristics described in the majority of published epidemiological studies and those found in patients in the north area of São Paulo City. It is likely that these differences reflect the urban and cultural habits and behaviors of the population specific to this area.
authors: Conjunto Hospitalar do Mandaqui, Neurosurgery Service, São Paulo, Brazil.
authors: Egmond Alves Silva
authors: EA
authors: Santos
authors: Wenner Jorzino Santos
authors: WJ
authors: Filho
authors: Lucas Loss
authors: LL
authors: Possatti
authors: Lia Rita Azeredo
authors: LR
authors: Bittencourt
authors: Emílio Afonso França
authors: EA
authors: Fontoura
authors: Ricardo Vieira
authors: RV
authors: Botelho
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014505:Urban Population