title: Fatal cervical spine injuries: a Finnish nationwide register-based epidemiologic study on data from 1987 to 2010.
abstract: The number of cervical spine injuries (CSIs) is increasing. Cervical spine injuries are associated with high morbidity and mortality. Identifying those who are at risk for CSI-related death can help develop national and international interventions and policies to reduce mortality.
  
  
  
  This study aimed to determine the trends in the incidence and the characteristics of fatal CSIs in Finland over a 24-year study period from 1987 to 2010.
  
  
  
  A large nationwide, retrospective, register-based study was carried out.
  
  
  
  The population-based sample was collected from death certificates issued in Finland between 1987 and 2010. The death certificates were obtained from the official Cause-of-Death Register, coordinated by Statistics Finland, which covers all deaths occurring in Finland.
  
  
  
  Sociodemographics and injury- and death-related data were used for outcome measures.
  
  
  
  All death certificates issued in Finland (1987-2010) containing a CSI as the cause of death were carefully reviewed.
  
  
  
  A total of 2,041 fatal CSIs were identified. These constituted 0.17% of all deaths in Finland within the study period. The average annual incidence of fatal CSIs was 16.5 per million (range: 12.5-21.2). The majority of the victims were male (72.9%) and had concurrent spinal cord injury (83.0%). Traffic accidents (40.1%) and falls (45.0%) were the most common injury mechanisms. Almost one-third (29.8%) of the deaths were alcohol-related. Among the young victims (<60 years) with upper CSI (C0-C2), the majority (91.8%) died within 24 hours post-injury. One-third of elderly victims' (≥60 years) CSI-related deaths occurred after 1 week post-injury and were mostly (74.2%) caused by respiratory and circulatory system diseases. Within the 24-year period, the incidence of fatal CSIs (+2/million), as well as the average age of sustaining a fatal CSI (+13.5 years), increased markedly. Fall-induced accidents among elderly males were the most prominently increasing subpopulation of fatal CSI victims.
  
  
  
  In recent decades, fatal CSI incidence (death certificate-based) has increased, being 18.6 per million in Finland in 2010. Victims of fatal CSIs tend to be older than in the past, and for a substantial number of males, low-energy falls lead to cervical trauma and death.
authors.affiliation: Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland. Electronic address: tuomo.thesleff@pshp.fi.
authors.forename: Tuomo
authors.initials: T
authors.lastname: Thesleff
authors.affiliation: Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Niskakangas
authors.affiliation: Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland.
authors.forename: Teemu M
authors.initials: TM
authors.lastname: Luoto
authors.affiliation: Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Öhman
authors.affiliation: Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, Tampere FI-33521, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Ronkainen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality
keywords: Autopsy; Epidemiology; Mortality; Registries; Spinal cord injuries; Spinal injuries