Multicenter epidemiological analysis of traumatic cervical spinal cord injury

English Keywords:Traumatic cervical spinal cord injury  Epidemiology  Demographic and clinical characteristics  Treatment status  Medical expenditure

English Abstract:

  【Abstract】 Objectives: To analyze the status and trends of demographic and clinical characteristics and the current status of surgical treatment and medical expenditure during hospitalization in patients with traumatic cervical spinal cord injury(TCSCI) from 2013 to 2018. Methods: The medical records of TCSCI inpatients of 13 hospitals in China[Xi′an Honghui Hospital, Shanghai East Hospital, Tianjin Medical University General Hospital, The First Affiliated Hospital of Soochow University, Shenzhen Second People′s Hospital, Shanghai First People′s Hospital, People′s Hospital of Xiushan County, The First Affiliated Hospital of Xi′an Jiaotong University, Xi′an No.141 Hospital(now the East Branch of the First Affiliated Hospital of Xi′an Jiaotong University), The Affiliated Hospital of Chengdu University, Jinhu County People′s Hospital, Xuanwu Hospital Capital Medical University, Hospital of Jingxing County] were collected. The data collected included gender, age, occupation, cause of injury, injury segment, injury severity, American Spinal Injury Association(ASIA) Impairment Scale(AIS grade), the treatment options, decompression surgical time windows, and time windows of corticosteroid drugs[methylprednisolone sodium succinate(MPSS) or methylprednisolone(MP)]. The medical expenses during hospitalization and length of hospital stay were also collected. The current status of the above clinical data was analyzed, and the annual percentage change(APC) was calculated to analyze the trends of the demographic and clinical characteristics over the 6-year period. The current status of treatment and expenditure was analyzed. Results: A total of 2102 TCSCI patients were included in this study. From 2013 to 2018, the number of TCSCI patients showed an increasing trend year by year(APC=16.9%, 95%CI: 10.2-24.1, P<0.01), and the average age of patients(APC=1.7%, 95%CI: 1.0-2.4, P<0.01) and the proportion of the elderly(APC=12.5%, 95%CI: 6.0-19.3, P<0.01) were on the rise constantly. In the study, 79.9% were male, and the most common occupation was farmer(32.8%). The top three causes of injuries were low fall(36.7%), traffic accident(30.0%) and high fall(18.4%). The most common segment of injury was C4 level(26.8%), followed by multi-segments injury(24.4%) and C5 level(18.9%). More than half of the patients were rated as incomplete quadriplegia(67.8%) and AIS D(51.9%). The proportion of paraplegia(including complete and incomplete) was decreasing. Decompression surgery was performed in 66.0% of the patients, but only 2.0% of them were performed within 24 hours after injury. 18.2% of the patients received high dose of MPSS/MP, and 34.2% of them received within 8 hours after injury. There were 173 patients(45.2%) who still used high dose MPSS/MP after 24 hours after injury. The average hospitalization cost in acute and sub-acute phase was 69.3 thousands yuan, and the average daily cost was 4.2 thousands yuan. The average of total medical expenses and daily medical expenses for male patients during hospitalization were higher than those of female patients. Among different injury severity groups, patients rated complete quadriplegia had the highest medical expenditure during hospitalization. Among different AIS grades, patients rated AIS A had the highest medical expenditure during hospitalization. Conclusions: The number, average age, and proportion of the elderly in TCSCI patients all increase year by year. In the actual clinical treatment of TCSCI patients, the time window of decompression surgery and the usage and dosage of corticosteroids are not completely consistent with the recommendations of the guidelines.