title: A global map for traumatic spinal cord injury epidemiology: towards a living data repository for injury prevention.
abstract: METHODS
  Literature review.
  
  
  OBJECTIVE
  To map traumatic spinal cord injury (TSCI) globally and provide a framework for an ongoing repository of data for prevention.
  
  
  METHODS
  An initiative of the ISCoS Prevention Committee.
  
  
  METHODS
  The results obtained from the search of Medline/Embase using search phrases: TSCI incidence, aetiology, prevalence and survival were analysed. Stratification of data into green/yellow/red quality 'zones' allowed comparison between data.
  
  
  RESULTS
  Reported global prevalence of TSCI is insufficient (236-1009 per million). Incidence data was comparable only for regions in North America (39 per million), Western Europe (15 per million) and Australia (16 per million). The major cause of TSCI in these regions involves four-wheeled motor vehicles, in contrast to South-east Asia where two-wheeled (and non-standard) road transport predominates. Southern Asia and Oceania have falls from rooftops and trees as the primary cause. High-fall rates are also seen in developed regions with aged populations (Japan/Western Europe). Violence/self-harm (mainly firearm-related) was higher in North America (15%) than either Western Europe (6%) or Australia (2%). Sub-Saharan Africa has the highest reported violence-related TSCI in the world (38%). Rates are also high in north Africa/Middle East (24%) and Latin America (22%). Developed countries have significantly improved TSCI survival compared with developing countries, particularly for tetraplegia. Developing countries have the highest 1-year mortality rates and in some countries in sub-Saharan Africa the occurrence of a spinal injury is likely to be a fatal condition within a year.
  
  
  CONCLUSIONS
  Missing prevalence and insufficient incidence data is a recurrent feature of this review. The piecemeal approach to epidemiological reporting of TSCI, particularly failing to include sound regional denominators has exhausted its utility. Minimum data collection standards are required.
authors.affiliation: School of Medicine at Flinders University, (Prevention, Promotion and Primary Health Care Cluster), Sydney, New South Wales, Australia.
authors.forename: R A
authors.initials: RA
authors.lastname: Cripps
authors.forename: B B
authors.initials: BB
authors.lastname: Lee
authors.forename: P
authors.initials: P
authors.lastname: Wing
authors.forename: E
authors.initials: E
authors.lastname: Weerts
authors.forename: J
authors.initials: J
authors.lastname: Mackay
authors.forename: D
authors.initials: D
authors.lastname: Brown
mesh_terms: D016208:Databases, Factual / Q000592:standards / Q000639:trends*; D014943:Global Health; D006801:Humans; D015994:Incidence; D015995:Prevalence; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*