title: Traumatic spinal cord injury in the United States, 1993-2012.
abstract: OBJECTIVE
  Acute traumatic spinal cord injury results in disability and use of health care resources, yet data on contemporary national trends of traumatic spinal cord injury incidence and etiology are limited.
  
  
  OBJECTIVE
  To assess trends in acute traumatic spinal cord injury incidence, etiology, mortality, and associated surgical procedures in the United States from 1993 to 2012.
  
  
  METHODS
  Analysis of survey data from the US Nationwide Inpatient Sample databases for 1993-2012, including a total of 63,109 patients with acute traumatic spinal cord injury.
  
  
  METHODS
  Age- and sex-stratified incidence of acute traumatic spinal cord injury; trends in etiology and in-hospital mortality of acute traumatic spinal cord injury.
  
  
  RESULTS
  In 1993, the estimated incidence of acute spinal cord injury was 53 cases (95% CI, 52-54 cases) per 1 million persons based on 2659 actual cases. In 2012, the estimated incidence was 54 cases (95% CI, 53-55 cases) per 1 million population based on 3393 cases (average annual percentage change, 0.2%; 95% CI, -0.5% to 0.9%). Incidence rates among the younger male population declined from 1993 to 2012: for age 16 to 24 years, from 144 cases/million (2405 cases) to 87 cases/million (1770 cases) (average annual percentage change, -2.5%; 95% CI, -3.3% to -1.8%); for age 25 to 44 years, from 96 cases/million (3959 cases) to 71 cases/million persons (2930 cases), (average annual percentage change, -1.2%; 95% CI, -2.1% to -0.3%). A high rate of increase was observed in men aged 65 to 74 years (from 84 cases/million in 1993 [695 cases] to 131 cases/million [1465 cases]; average annual percentage change, 2.7%; 95% CI, 2.0%-3.5%). The percentage of spinal cord injury associated with falls increased significantly from 28% (95% CI, 26%-30%) in 1997-2000 to 66% (95% CI, 64%-68%) in 2010-2012 in those aged 65 years or older (P < .001). Although overall in-hospital mortality increased from 6.6% (95% CI, 6.1%-7.0%) in 1993-1996 to 7.5% (95% CI, 7.0%-8.0%) in 2010-2012 (P < .001), mortality decreased significantly from 24.2% (95% CI, 19.7%-28.7%) in 1993-1996 to 20.1% (95% CI, 17.0%-23.2%) in 2010-2012 (P = .003) among persons aged 85 years or older.
  
  
  CONCLUSIONS
  Between 1993 and 2012, the incidence rate of acute traumatic spinal cord injury remained relatively stable but, reflecting an increasing population, the total number of cases increased. The largest increase in incidence was observed in older patients, largely associated with an increase in falls, and in-hospital mortality remained high, especially among elderly persons.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee2Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Ayers
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Peterson
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts5Harvard Medical School, Boston, Massachusetts.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Harvard Medical School, Boston, Massachusetts6Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.
authors.forename: Leslie
authors.initials: L
authors.lastname: Morse
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: O'Connor
authors.affiliation: Harvard Medical School, Boston, Massachusetts7Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts8Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Eric
authors.initials: E
authors.lastname: Garshick
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000639:trends; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000150:complications / Q000453:epidemiology; D055815:Young Adult