Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. Methods: A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. Results: Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. Conclusion: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.

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Mortality and longevity after a spinal cord injury: systematic review and meta-analysis.

Literature review. To explore the prevalence or incidence, risk factors, and costs of pressure ulcers among individuals with spinal cord injury (SCI), specifically in the context of the developing world. To highlight important targets for intervention and research for pressure ulcer management the world over. World Bank ‘low-income’ and ‘middle-income’ countries with a gross national income per capita <$12 746. PubMed search. SCI-associated pressure ulcers are very prevalent in developing nations; however, reported prevalence and incidence numbers are highly variable. Risk factors for pressure ulcers are similar in developed and developing countries however many of the risk factors are more prevalent in developing nations. SCI-associated pressure ulcers are common but can be prevented in the developing world. Key targets for interventions include acute care, nurse-to-patient ratios, support surfaces and education.

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Pressure ulcers in people with spinal cord injury in developing nations.

Mixed retrospective-prospective cohort study. To determine 2-year survival following discharge from hospital after spinal cord injury in Bangladesh. Bangladesh. Medical records were used to identify all patients admitted in 2011 with a recent spinal cord injury to the Centre for Rehabilitation of the Paralysed, a large Bangladeshi hospital that specialises in care of people with spinal cord injury. Patients or their families were subsequently visited or contacted by telephone in 2014. Vital status and, where relevant, date and cause of death were determined by verbal autopsy. 350 of 371 people admitted with a recent spinal cord injury in 2011 were discharged alive from hospital. All but eleven were accounted for two years after discharge (97% follow-up). Two-year survival was 87% (95% CI 83% to 90%). Two-year survival of those who were wheelchair-dependent was 81% (95% CI 76% to 86%). The most common cause of death was sepsis due to pressure ulcers. In Bangladesh, approximately one in five people with spinal cord injury who are wheelchair-dependent die within two years of discharge from hospital. Most deaths are due to sepsis from potentially preventable pressure ulcers.

Two-year survival following discharge from hospital after spinal cord injury in Bangladesh.

Purpose: Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a ...

Wheelchair service provision education and training in low and lower middle income countries: a scoping review

Objective: This study compares functional status, quality of life and community integration in 2008 Sichuan earthquake survivors with spinal cord injury at hospital discharge and at 1-year follow-up in the community. Methods: Twenty-six subjects with spinal cord injury completed demographic and medical questionnaires and underwent medical examination at discharge from a hospital rehabilitation department and after 1 year in the community. Functional status, quality of life and community integration were assessed by appropriate instruments over this period. Results: Functional status measures showed significantly increased (p < 0.05) scores for the Modified Barthel Index and Walking Index for Spinal Cord Injury II; depression and pain scores were reduced with no statistical significance. After discharge, nearly half of patients developed a new pressure sore and most patients had urinary complications. Selfreported quality of life, overall health, and satisfaction with social relationships increased significantly (p < 0.05), while the environment domain was reduced (p < 0.05). Social participation (i.e. community integration) results showed an improvement in physical independence and mobility (p < 0.05), but a decline in cognitive independence (p < 0.05). Only 15% of the population returned to work. Conclusion: Special attention should be paid to cognitive and emotional function, occupational training and social integration during rehabilitation measures after earthquakes.

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Analysis of functional status, quality of life and community integration in earthquake survivors with spinal cord injury at hospital discharge and one-year follow-up in the community

Observational cohort study. To evaluate ongoing health and community reintegration of patients with spinal cord injury (SCI) after discharge from inpatient rehabilitation in Nepal. Nepal. This study follows a cohort of 37 patients with SCI in Nepal, 1–2 years after discharge from inpatient rehabilitation in 2007. Participants were visited at home and data were obtained through semi-structured interviews that evaluated health, independence in daily living (Modified Barthel Index), community participation (Participation Scale) and barriers due to socioeconomic issues, housing, accessibility, and availability and use of mobility aids. One-quarter of the cohort had died (35% of wheelchair users). Secondary health concerns, such as pressure ulcers and urinary tract infections, were common in the 24 patients interviewed, and eight had been rehospitalized to treat them. Inappropriate wheelchairs, inadequate housing and rugged terrain restricted accessibility. 80% of wheelchair users could not enter their homes independently and 74% of those who were using mobility aids could not access the community independently because of the physical terrain. Of all those who were interviewed, half had no accessible toilet, access to a water source or road access to their home. Community participation was a challenge for most using mobility devices, and less than half earned any income. This study identifies important areas of focus for rehabilitation centres in less-resourced contexts like Nepal to help with reintegration after discharge: vocational training during or after rehabilitation; accessible housing; wheelchairs appropriate to the terrain and the need for strong community-based rehabilitation.

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I B Craighead

Papers

Follow-up study of spinal cord injured patients after discharge from inpatient rehabilitation in Nepal in 2007.