The Stockholm spinal cord injury study : medical, economical and psycho-social outcomes in a prevalence population

Sammanfattning: R LevL The Stockholm Spinal Cord Injury Study: Medical, Economical and Psycho-socialOutcomes In a Prevalence Population.Doctoral Dissertation 1996. Department or Clinical Neuroscienee and Family Medicine, Karolinska Institute,171 77 Stockholm SwedenThe first stage or the SSCIS, presented in this thesis. is based on a near-total regional prevalence population of353 individuals with traumatic SCI. Medical, economic, and psycho-social variables were assessed by semi-structured individual interview, physical examination, questionnaires and review of medical records.Comparisons were made with a normative population sample. A computerised medical record system was adaptedand implemented as the instrument for structuring investigations, data storage and processing.The main findings were:1 Motor vehicle accidents accounted for almost 5O% or cases, followed by falls (including diving), whichaccounted for more than 30% or cases.2. Mean age at injury was 31 years. Over 5O% of injuries occurred in the 16-30 year age group.3. The male:female ratio was 4:1.4. The paraplegia:tetraplegia ratio was3:2.5. The incomlete:complete ratio was 3:2.6. About 70% had experienced urinary tract infections7. About 40% had experienced decubitus ulcers.8. About 20% had experienced urolithiasis, fractures, and spinal deformity, respectively.9. Additionally, a wide range of less common complications from most organ systems were reported.10. Problematic spasticity (among subjeets with spastic paresis), and significant bladder and bowel dysfunetion(most commonly due to incontinenee and/or frequent infections, and constipation, respectively) all occurred inabout 40%.11. Signficant chronic pain, most commonly of neurogenic type, was reported by about 70%.12. Neurological deterioration was reported by about 30%. In 10%. this included sensorimotor loss.13. Significant sexual dysfunction was reported by 5O% of males and 25% of females. Almost 30% had not hadsexual intereourse after injury.14. Over 70% relied partially or totally on sick-pension.15. Differing vulnerability across SCI subgroups: a. More sexual problems and spasticity in malesb. More fractures, spinal deformity, shoulder/neek pain, anxiety and fatigue in femalese. More pain in those injured at older age d. More spinal deformity in those injured at younger age e. More medical problems and retirement in high and/or complete lesions16 Differences between the SCI versus normative group:a. Inferior health status, higher rate of health care consumption and sick-pensionb. More pain, bladderproblems, fatigue, anxiety and insomnia c. More use of antibiotics, laxatives, analgesics, sedatives, hypnoticsd. No increased prevalenee of heart disease. hypertension. diabetes, tumorse. Inferior "intrinsic" economy f. More restricted social activitiesThe main implications of the SSCISa primary prevention programs should focus on the distinct high-risk groups and situations, and be designcd tosuit the target groupb. tertiary prevention programs are necessary and should include life-long, structured regular follow-up of allSCI patients by qualified and specialised staff,with a high degree of vigilanee for prevention and early detectionof complications and serious functional impairments, and a more aggressive approach towards treatment or suchproblemsc. the high prevalence or severe neurogenie pain and neurological deterioration should lead to increasedawareness of these problems, and intensified research in rehabilitative neurosurgery and other treatmentmodalitiesd. intensified vocational rehabilitation rather than sick-pension and further subsidies as primary means forenhancing economical and psycho-social outcomese. implementation of computer and information technology to facilitate functional centralisation of SCI care in"virtual" SCI unitsKEY WORDS: Computers, out-patient care. spinal cord injury, epidemiology, outcome. complications,neurological deterioration, health related issuesIS8N 91-628-1991-7