title: Changing demographics of spinal cord injury over a 20-year period: a longitudinal population-based study in Scotland.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  To review demographic trends in traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI).
  
  
  METHODS
  The Queen Elizabeth National Spinal Injuries Unit (QENSIU), sole provider of treatment for TSCI in Scotland; a devolved region of the UK National Health Service.
  
  
  METHODS
  A retrospective review of the QENSIU database was performed between 1994 and 2013. This database includes demographic and clinical data from all new TSCI patients in Scotland, as well as patients with severe NTSCI.
  
  
  RESULTS
  Over this 20-year period there were 1638 new cases of TSCI in Scotland; 75.2% occurring in males. TSCI incidence increased non-significantly (13.3 per million population to 17.0), while there were significant increases in mean age at time of TSCI (44.1-52.6 years), the proportion of TSCIs caused by falls (41-60%), the proportion of TSCIs resulting in an American Spinal Injury Association Impairment Scale score of C and D on admission (19.7-28.6% and 34.5-39.5%, respectively) and the proportion of cervical TSCIs (58.4-66.3%). The increase in cervical TSCI was specifically due to an increase in C1-C4 lesions (21.7-31.2%). NTSCI patients (n=292) were 5 years older at injury, more likely to be female (68.1% male) and had a range of diagnoses.
  
  
  CONCLUSIONS
  This study supports the suggestion that demographic profiles in SCI are subject to change. In this population, of particular concern is the increasing number of older patients and those with high level tetraplegia, due to their increased care needs. Prevention programmes, treatment pathways and service provision need to be adjusted for optimum impact, improved outcome and long-term care for their target population.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia.|Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.|Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.|Scottish Centre for Innovation in Spinal Cord Injury, Glasgow, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: McCaughey
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.|Scottish Centre for Innovation in Spinal Cord Injury, Glasgow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Purcell
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.|Scottish Centre for Innovation in Spinal Cord Injury, Glasgow, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: McLean
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.|Scottish Centre for Innovation in Spinal Cord Injury, Glasgow, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Fraser
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bewick
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia.|Bloomberg School of Public Health, John Hopkins University, MD, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Borotkanics
authors.affiliation: Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK.|Scottish Centre for Innovation in Spinal Cord Injury, Glasgow, UK.
authors.forename: D B
authors.initials: DB
authors.lastname: Allan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018672:Community Health Planning; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult