title: Impact of fatal cases on the epidemiology of traumatic spinal cord injury in Estonia.
abstract: OBJECTIVE
  Most epidemiological studies on traumatic spinal cord injury (TSCI) have not included patients who die before hospitalization. The aim of the research was to study the incidence of TSCI by including the individuals who die at the scene of the accident in addition to data retrieved from all hospitals in Estonia.
  
  
  METHODS
  Medical records of patients with TSCI from all hospitals in Estonia from 2005 to 2007 were studied. With collaboration from the Estonian Forensic Science Institute the data of the victims of TSCI who died before hospitalization were included.
  
  
  RESULTS
  From 2005 to 2007, 391 TSCI cases were identified: 183 patients were found retrospectively from medical records and 208 cases were detected from autopsy reports. Fifty-three per cent of patients died before hospitalization. The annual incidence rate was 97.0 per million population (95% confidence interval 87.4-106.6). The mean age at injury was 44.4 ± 18.7 years. Motor vehicle accidents were the leading cause of TSCI amongst the individuals who died before hospitalization (75%). Falls accounted for the highest number of TSCIs (43%) amongst the patients who reached hospital.
  
  
  CONCLUSIONS
  Our study shows that, when the cases that die at the scene of the accident are included, the incidence of TSCI in Estonia rises from 39.7 to 97.0 per million population.
authors.affiliation: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
authors.forename: L
authors.initials: L
authors.lastname: Sabre
authors.forename: S
authors.initials: S
authors.lastname: Remmer
authors.forename: A
authors.initials: A
authors.lastname: Adams
authors.forename: M
authors.initials: M
authors.lastname: Väli
authors.forename: T
authors.initials: T
authors.lastname: Rekand
authors.forename: T
authors.initials: T
authors.lastname: Asser
authors.forename: J
authors.initials: J
authors.lastname: Kõrv
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000401:mortality*; D055815:Young Adult
keywords: early mortality; incidence; traumatic spinal cord injury