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Acute Traumatic Spinal Cord Injury Surveillance -- United States, 1987

In 1987, the Council of State and Territorial Epidemiologists (CSTE) recommended designating traumatic spinal cord injuries (SCIs) as the first injury condition reportable to state health agencies and to CDC. In that same year, two surveys were conducted to identify existing registries for SCIs in the United States. One survey, which was conducted by the Spinal Cord Injury Program in Florida, used a computer- based information exchange system to gather information from vocational rehabilitation agencies. Agencies in 82% (42 of 51) of the states and the District of Columbia replied. The second, a telephone survey, was conducted independently by the National Spinal Cord Injury Association (NSCIA).* State health departments in all 50 states** were contacted.

Each survey identified eight states as having SCI registries; however, the results of the surveys differed. These results and information obtained by personal communication indicate that the following 14 states have registries for traumatic SCI: Alabama, Arkansas, Colorado, Florida, Georgia, Iowa, Louisiana, Maryland, Missouri, Oklahoma, New Jersey, North Dakota, Virginia, and West Virginia. In ten states, reporting is mandated by law; it is voluntary in the remaining four states. In most states, SCI data are collected to aid in planning for rehabilitative services. Reported by: the Spinal Cord Injury Program, Div of Vocational Rehabilitation, Dept of Labor and Employment Security, Tallahassee, Florida. J Spack, JD, National Spinal Cord Injury Assoc, Woburn, Massachusetts. GR Istre, MD, State Epidemiologist, Oklahoma State Dept of Health. Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC. Editorial Note: CSTE's recommendation to designate SCIs as reportable was based on the magnitude of the morbidity and mortality due to traumatic SCIs, the cost associated with these injuries, and the potential for their prevention. It is a practical choice because the number of cases is manageable and consensus can be reached on the case definition.

Estimates of the incidence of acute traumatic SCI in the United States range between 28 and 50 injuries per million persons per year (1). At present, there are over 200,000 cases of SCI in the United States (2). Older adolescent and young adult males are at high risk for SCI. The consequences of injury for persons in these age groups include reduced lifetime employment, limited productivity, and decreased quality of life. Injured individuals may also need special services throughout life (1). The direct medical costs of these injuries to the federal government exceed $4 billion per year (3). Lost earnings associated with SCI are estimated to be $3.4 billion (in 1987 dollars) annually (Department of Rehabilitation Medicine, University of Alabama/ Birmingham, unpublished data).

Surveillance is needed to better define the national incidence of acute traumatic SCI, to identify high-risk groups in order to target prevention strategies, and to determine etiologies so that prevention programs can be developed. The data presently collected by SCI registries may be useful in targeting high-risk groups and determining etiologies. However, case definitions, reporting sources, and level of information collected vary among registries.

CDC is working with CSTE and other interested groups to 1) review existing surveillance systems and registries for acute traumatic SCI, 2) determine the information needs of public health and clinical practice, 3) develop a workable case definition, 4) determine the information to be collected, and 5) identify reporting sources. SCI is one of the disabilities targeted for support by CDC's disabilities prevention program. This program will provide state and local agencies with funding to prevent primary and secondary disabilities such as those caused by acute traumatic SCIs.

The public health benefit of registries at the local level can be realized only if the information collected is useful to those planning intervention strategies. The implementation of these strategies may involve the participation of many agencies within the state or local government, along with private interest groups. Registries will be useful at the national level only if a standard case definition is used and if information is collected, analyzed, and interpreted consistently and systematically. References

  1. Kraus JF. Epidemiological aspects of acute spinal cord injury: a review of incidence, prevalence, causes, and outcome. In: Becker DP, Povlishock JT, eds. Central nervous system trauma status report--1985. Bethesda, Maryland: National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, 1985:313-22.

  2. DeVivo MJ, Fine PR, Maetz HM, Stover SL. Prevalence of spinal cord injury: a reestimation employing life table techniques. Arch Neurol 1980;37:707-8.

  3. Ergas Z. Spinal cord injury in the United States: a statistical update. Cent Nerv Syst Trauma 1985;2:31-2. *NSCIA is a private, nonprofit national health agency that serves as a resource and clearinghouse for information on SCIs, including prevention and rehabilitation. **The District of Columbia was not contacted.

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