title: The epidemiology of pre-hospital potential spinal cord injuries in Victoria, Australia: a six year retrospective cohort study.
abstract: BACKGROUND
  Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI.
  
  
  METHODS
  This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI. Data was extracted from the AV data warehouse, including demographic details, trauma aetiology, paramedic assessment, management and other event characteristics.
  
  
  RESULTS
  A total of 106,059cases were included in the study, representing 2.3 % of all emergency transports by AV. Subjects had a median age of 51 years (interquartile range; 29-78) and 52.4 % were males (95 % CI 52-52.7). Males were significantly younger than females (M: 43 years [26-65] vs. F: 64 years [36-84], p =0.001). Falls and traffic accidents were the leading causes of injuries, comprising 46.9 and 39.4 % of cases, respectively. Other causes included accidents due to sport, animals, industrial work and diving, as well as violence and hanging. 29.9 % of patients were transported to a Major Trauma Service (MTS). A proportion of 48.8 % of the study population met the Pre-hospital Major Trauma criteria.
  
  
  CONCLUSIONS
  This is the first study to describe the epidemiology of potential TSCI in Australia and is based on a large, state-wide sample. It provides background knowledge and a baseline for future research, as well as a reference point for future in policy. Falling and traffic related injuries were the leading causes of potential SCI. Future research is required to identify the proportion of confirmed TSCI among the potentials and factors associated with TSCI in prehospital settings.
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Building 3, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Ala'a O
authors.initials: AO
authors.lastname: Oteir
authors.affiliation: Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Johannes U
authors.initials: JU
authors.lastname: Stoelwinder
authors.affiliation: Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Shelley
authors.initials: S
authors.lastname: Cox
authors.affiliation: John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards and Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia.
authors.forename: James W
authors.initials: JW
authors.lastname: Middleton
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Building 3, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. paul.jennings@monash.edu.|Ambulance Victoria, Melbourne, Victoria, Australia. paul.jennings@monash.edu.|Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. paul.jennings@monash.edu.|College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia. paul.jennings@monash.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
keywords: Emergency Medical Services; Epidemiology; Potential SCI; Pre-hospital; Suspected SCI; TSCI; Trauma; Traumatic SCI