¶ These authors also contributed equally to this work.
The authors have declared that no competing interests exist.
Conceived and designed the experiments: RY LG HYS YFW. Performed the experiments: RY LG HYS YFW PW LH YT WHW KC JCY CYL. Analyzed the data: RY LG. Contributed reagents/materials/analysis tools: RY LG. Wrote the paper: RY LG. Conceived the study, participated in its design and helped to draft the manuscript: RY LG. Participated in article revision and academic counseling: PW LH YT WHW KC JCY CL YFW HYS. Read and approved the final manuscript: RY LG PW LH YT WHW KC JCY CL YFW HYS.
Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries.
A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries.
The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0∶1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07–1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35–2.60), the OR (95%CI) for having a thoracic injury was 1.23 (1.10–2.00), and the OR (95%CI) for having complications was 2.47 (1.96–3.13).
The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males.
In a spinal cord injury (SCI), the structures and functions of the spinal cord are damaged by trauma, inflammation, tumors or other causes, resulting in dysfunction of motion, feeling, sphincters and autonomic nerves below the damaged plane. A SCI is a highly disabling and deadly injury. Based on their etiology, SCIs can be divided into two different groups: traumatic spinal cord injuries (TSCI) and non-traumatic spinal cord injuries (NTSCI)
According to the international standards set forth by the American Spinal Injury Association (ASIA), the severity of an injury is categorized as either complete or incomplete. A complete injury is defined as the absence of sensory and motor function in the lowest sacral segments
In China, hospitals are categorized by medical level into three grades (third-grade is the best), and each grade is divided into three classes from better to worse: A, B, and C. The study used typical sampling techniques to select partial second-grade class-A hospitals (mainly capturing general city and county hospitals and some large-scale affiliated hospitals) in Guangzhou, Shantou, Shaoguan, and Zhanjiang according to the geography and the economic characteristics of Guangdong province. The subjects were 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals between 2003 and 2011. For this process, spinal cord injury was defined using the international definition as the occurrence of an acute lesion on the neural elements in the spinal canal (spinal cord and cauda equina), resulting in temporary or permanent sensory deficits, motor deficits, or bladder/bowel dysfunction.
This study was approved by the ethics committee of the Sun Yat-sen Memorial Hospital of Sun Yat-sen University. The research assistants collected all the required data by reviewing the medical records of the sampled hospitals, concealed any identifiable details about the patients, and recorded these blind data in a privacy-enhanced database. Next, the researchers were allowed to read and analyze the data. The institutional review boards of the sampled hospitals permitted the review process, and the need for the patients' written informed consent was waived.
This retrospective study used questionnaires to review medical records and to obtain the relevant data. The questionnaire about the patients included the patients' age, gender, residence, ethic group, occupation, marital status, time of injury, hospital admission and discharge date, cause of injury, level of injury, severity of injury, acceptance of surgical treatment, traction, hyperbaric oxygen therapy, rehabilitation therapy and so on. The time period was subdivided into three sub-periods: 2003–2005, 2006–2008, and 2009–2011. The patients were divided into four age groups: ≤20, 21–40, 41–60, and ≥61 years. The place of residence was defined as either Guangdong or other, and the patient's ethnic group was classified as either Han or other. Occupations were categorized as peasants, workers, students, retired individuals, unemployed individuals, self-employed individuals, enterprise staffs, civil servants and all other occupations not classified above. Marital status was defined as married, unmarried, divorced, or widowed. The specific causes of injury were classified as non-traumatic causes or traumatic causes, which included traffic accidents, being struck by falling objects, high falls (height>1 m), low falls (height≤1 m), crushing injuries, violence, and sports-related injuries. The levels of injury were associated with the mechanism of the injury and the structures of the spinal column: they were separated into cervical, thoracic, and lumbar spine segments. For the purposes and the practical conditions of the present study, the severity of the injury causing the neurological deficits was categorized as either complete or incomplete according to the international standards set forth by the American Spinal Association (ASIA). A complete injury was defined as the absence of sensory and motor function in the lowest sacral segments. An incomplete injury was defined as an SCI in which sensory and/or motor function (≥3 segments) is partially preserved below the level of injury and including the lowest sacral segments
All the data were entered twice by two investigators independently using Epidata 3.1 and analyzed using IBM SPSS Statistics 20.0 (IBM, Armonk, NY, USA). In the study, a descriptive analysis was performed on the demographics and injury characteristics to help with the prevention of SCI. Categorical and continuous data are reported as proportions and means ± SDs. Chi-square tests were used to test the differences between the categorical variables. A logistic regression model was used to analyze the relationships between two or more variables so that a dependent qualitative variable could be predicted by the other(s). The odds ratios derived from the logistic regression analysis estimated the likelihood of a given outcome among persons with a particular characteristic relative to those without that characteristic. In this study, the outcome of interest was the severity of the injury. Unconditional univariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the severity of the injury and the injury/demographic characteristics. The multivariate logistic regression models included the significant variables from the univariate logistic regression analysis to determine the risk factors for complete injuries based on the ORs and 95% CIs. An OR>1 with
The study included the medical records of 3,832 patients with spinal cord injuries from 2003 to 2011. Although the total number of ward beds in the study hospitals remained unchanged over the study period, the proportion of SCI admissions increased (
Of the 3,832 individuals with SCIs, 2,892 were male (75.5%), 940 were female (24.5%), and the male-to-female ratio was approximately 3.0∶1. The patients' ages ranged from 1 to 94 years, the mean age was 42.4±15.3 years, and the median age was 42.0 years old. The age group with the greatest percentage of patients was 41–60 years (36.4%), followed by 21–40 years (35.5%); thus, young adults are the high-risk population. The occupations of the patients with SCIs included workers (36.2%), peasants (22.8%), unemployed persons (13.9%), retired persons (6.9%), civil servants (3.4%), students (3.0%), self-employed persons (2.1%), enterprise staffs (1.1%), and other occupations that were difficult to classify (10.5%). The most common occupational groups were workers (36.2%), peasants (22.8%), and unemployed persons (13.9%), who together accounted for 72.9% of the total. The main ethnic group was Han, which accounted for 92.7% of the SCI patients, and the other ethnic groups included Zhuang (3.2%), Miao (3.1%) and Tujia (1.0%). The proportion of patients who resided in Guangdong was 69.3%. More than 70% of the SCI patients were married (
Variables | Numbers (%) |
3832 (100.0) | |
Male | 2892 (75.5) |
Female | 940 (24.5) |
≤20 | 376(9.8) |
21–40 | 1361 (35.5) |
41–60 | 1394 (36.4) |
≥61 | 478 (12.5) |
Workers | 1387 (36.2) |
Peasants | 873 (22.8) |
Unemployed | 533 (13.9) |
Retired | 265 (6.9) |
Other occupations |
371 (9.6) |
Other |
403 (10.5) |
Han | 3554 (92.7) |
Zhuang | 122 (3.2) |
Miao | 119 (3.1) |
Tujia | 37 (1.0) |
Guangdong | 2654 (69.3) |
Other | 919 (24.0) |
Unknown | 259 (6.7) |
Married | 2754 (71.9) |
Unmarried | 776 (20.3) |
Divorced | 12 (0.3) |
Widowed | 8 (0.2) |
Unknown | 282 (7.3) |
A total of 223 patients' medical records were missing age information.
Other occupations included self-employed people, civil servants, students, and enterprise staff.
Other referred to all other occupations not classified above.
Spinal cord injuries can be divided into traumatic and non-traumatic injuries. The four main causes of injury were traumatic injuries, including traffic accidents (21.7%), being struck by falling objects (19.5%), crushing injuries (15.1%) and high falls (9.8%), followed by low falls (3.8%), violence (3.2%), non-traumatic causes (8.2%), sports-related injuries (0.7%), and other unknown causes (18.1%). In this study, inflammation (0.9%), tumors (0.9%), ossification (2.9%), degenerative damage (2.8%) and vascular damage (0.7%) comprised the non-traumatic causes. Over the study period, the number of patients admitted to the sampled hospitals increased steadily. The final data revealed that traffic accidents were the leading cause of SCIs in all three study periods, but there were statistically significant differences in the distribution of the etiology during the different periods (
Variables | Etiologies, n (%) | ||||||||
Traffic accidents | Struck |
Crushing injuries | High falls | Other |
Non-traumatic |
Unknown | Total | ||
831 (21.7) | 746 (19.5) | 577 (15.1) | 374 (9.8) | 298 (7.7) | 313 (8.2) | 692 (18.1) | 3832 (100.0) | ||
0.023 | |||||||||
2003∼2005 | 235 (22.1) | 189 (17.8) | 175 (16.5) | 110 (10.4) | 78 (7.3) | 88 (8.3) | 187 (17.6) | 1062 (27.7) | |
2006∼2008 | 291 (22.3) | 254 (19.5) | 193 (14.8) | 122 (9.4) | 102 (7.8) | 122 (9.4) | 220 (16.9) | 1304 (34.0) | |
2009∼2011 | 305 (20.8) | 303 (20.7) | 210 (14.3) | 142 (9.7) | 118 (8.0) | 103 (7.0) | 285 (19.4) | 1466 (38.2) | |
0.036 | |||||||||
Male | 713 (24.7) | 620 (21.4) | 469 (16.2) | 240 (8.3) | 265 (9.2) | 245 (8.5) | 340 (11.8) | 2892 (75.4) | |
Female | 118 (12.6) | 126 (13.4) | 109 (11.6) | 134 (14.3) | 33 (3.5) | 68 (7.2) | 352 (37.4) | 940 (24.6) | |
<.001 | |||||||||
≤20 | 100 (26.6) | 41 (10.9) | 50 (13.3) | 52 (13.8) | 35 (9.3) | 25 (6.6) | 73 (19.4) | 376 (9.8) | |
21–40 | 365 (26.8) | 280 (20.6) | 208 (15.3) | 104 (7.6) | 121 (8.9) | 39 (2.9) | 244 (17.9) | 1361 (35.5) | |
41–60 | 346 (24.8) | 318 (22.8) | 207 (14.8) | 136 (9.8) | 128 (9.2) | 68 (4.9) | 191 (13.7) | 1394 (36.4) | |
≥61 | 13 (2.7) | 96 (20.0) | 90 (18.8) | 73 (15.3) | 81 (16.9) | 8 (1.7) | 117 (24.5) | 478 (12.5) |
NOTE. Total number of cases: N = 3832.
Struck = struck by falling objects.
Other included low falls, violence, and sports-related injuries.
Non-traumatic referred to inflammation, tumor, ossification, degenerative damage, and vascular damage.
A total of 223 patients' medical records were missing age information.
Variables | Etiologies, n (%) | ||||||||
Traffic accidents | Struck |
Crushing injuries | High falls | Other |
Non-traumatic |
Unknown | Total | ||
<.001 | |||||||||
Workers | 305 (22.0) | 257 (18.5) | 245 (17.7) | 103 (7.4) | 102 (7.4) | 139 (10.0) | 236 (17.0) | 1387 (36.2) | |
Peasants | 204 (23.4) | 104 (11.9) | 96 (11.0) | 162 (18.6) | 93 (10.7) | 30 (3.4) | 184 (21.1) | 873 (22.8) | |
Unemployed | 138 (25.9) | 132 (24.8) | 88 (16.5) | 23 (4.3) | 15 (2.8) | 33 (6.2) | 104 (19.5) | 533 (13.9) | |
Retired | 88 (33.2) | 13 (4.9) | 24 (9.0) | 56 (21.1) | 28 (10.6) | 45 (17.0) | 11 (4.2) | 265 (6.9) | |
Other occupations |
54 (14.6) | 121 (32.6) | 85 (22.9) | 22 (5.9) | 32 (8.6) | 28 (7.5) | 29 (7.8) | 371 (9.7) | |
Other | 42 (10.4) | 119 (29.5) | 40 (9.9) | 8 (2.0) | 28 (6.9) | 38 (9.4) | 128 (31.8) | 403 (10.5) | |
0.810 | |||||||||
Married | 619 (22.5) | 542 (19.7) | 389 (14.1) | 225 (8.2) | 209 (7.6) | 164 (6.0) | 606 (22.0) | 2754 (71.9) | |
Unmarried | 156 (20.1) | 174 (22.4) | 165 (21.3) | 118 (15.2) | 35 (4.5) | 72 (9.3) | 56 (7.2) | 776 (20.3) | |
Divorced | 3 (25.0) | 5 (41.7) | 0 (0) | 0 (0) | 2 (16.7) | 0 (0) | 2 (16.7) | 12 (0.3) | |
Widowed | 2 (25.0) | 1 (12.5) | 0 (0) | 0 (0) | 2 (25.0) | 2 (25.0) | 1 (12.5) | 8 (0.2) | |
Unknown | 51 (18.1) | 24 (8.5) | 24 (8.5) | 31 (11.0) | 50 (17.7) | 75 (26.6) | 27 (9.6) | 282 (7.3) |
NOTE. Total number of cases: N = 3832.
Struck = struck by falling objects.
Other included low falls, violence, and sports-related injuries.
Non-traumatic referred to inflammation, tumor, ossification, degenerative damage, and vascular damage.
Other occupations included self-employed people, civil servants, students, and enterprise staff.
As shown in
Level of injury | Severity of injury, n (%) | |||
Complete | Incomplete | Total | ||
<.001 | ||||
Yes | 375 (21.8) | 1345 (78.2) | 1720 (44.9) | |
No | 303 (14.3) | 1809 (85.7) | 2112 (55.1) | |
<.001 | ||||
Yes | 185 (14.6) | 1079 (85.4) | 1264 (33.0) | |
No | 493 (19.2) | 2075 (80.8) | 2568 (67.0) | |
0.016 | ||||
Yes | 141 (15.0) | 800 (85.0) | 941 (24.6) | |
No | 537 (18.6) | 2354 (81.4) | 2891 (75.4) | |
678 (17.7) | 3154 (82.3) | 3832 (100.0) |
As shown in
Associated injury | Severity of injury, n (%) | |||
Complete | Incomplete | Total | ||
<.001 | ||||
Yes | 442 (23.7) | 1422 (76.3) | 1864 (48.6) | |
No | 236 (12.0) | 1732 (88.0) | 1968(51.4) | |
<.001 | ||||
Yes | 161 (26.3) | 452 (73.7) | 613 (16.0) | |
No | 517 (16.1) | 2702 (83.9) | 3219 (84.0) | |
<.001 | ||||
Yes | 89 (25.4) | 261 (74.6) | 350 (9.1) | |
No | 589 (16.9) | 2893 (83.1) | 3482 (90.9) | |
678 (17.7) | 3154 (82.3) | 3832 (100.0) |
In this study, 12.8% of the SCI patients experienced clinical complications. The number of complication cases increased from 13 to 491 cases during the study period. The four main complications were pulmonary infections (37.6%), urinary tract infections (26.3%), bedsores (13.6%), and electrolyte disturbances (10.3%). As shown in
Complication | Severity of injury, n (%) | Total | |
Complete | Incomplete | ||
Pulmonary infection | 95 (51.4) | 90 (48.6) | 185 (37.6) |
Urinary tract infection | 49 (38.0) | 80 (62.0) | 129 (26.3) |
Bedsore | 22 (32.8) | 45 (67.2) | 67 (13.6) |
Electrolyte disturbance | 13 (25.5) | 38 (74.5) | 51 (10.3) |
Deep venous thrombosis | 4 (28.6) | 10 (71.4) | 14 (2.8) |
Digestive system disease | 4 (28.6) | 10 (71.4) | 14 (2.8) |
Urinary calculus | 4 (40.0) | 6 (60.0) | 10 (2.0) |
Spasms | 0 (0) | 4 (100.0) | 4 (0.8) |
Autonomic dysreflexia | 2 (66.7) | 1 (33.3) | 3 (0.6) |
Cardiovascular diseases | 1 (33.3) | 2 (66.7) | 3 (0.6) |
Osteoporosis | 0 (0) | 1 (100.0) | 1 (0.2) |
Other | 6 (60.0) | 4 (40.0) | 10 (2.0) |
200 (40.7) | 291 (59.3) | 491 (100.0) |
The total number in this table was 491, which referred to the number of patients with complications; the total number (n) of patients in this study was 3832.
The risk factors for a complete SCI were investigated by performing a univariate logistic regression analysis. In the model for the analysis, the dependent variable was the severity of the injury, and the independent variables, which included the significant variables from the chi-square tests and the variables considered relevant from modeling expertise (including age group, gender, having a spinal fracture or not, having complications or not, etiology, level of injury, marital status and occupation). The results showed that male gender (OR = 1.33, 95% CI: 1.06–1.67), having a spinal fracture (OR = 2.34, 95% CI: 1.97–2.79), having complications (OR = 3.42, 95% CI: 2.76–4.23), having a cervical injury (OR = 1.69, 95% CI: 1.43–2.00), and having a thoracic injury (OR = 2.25, 95% CI: 1.85–2.73) resulted relatively more often in complete injuries. The unmarried patients were at a higher risk for complete injuries than the married patients (OR = 1.46, 95% CI = 1.15–1.86). In contrast, patients with lumbar injuries (OR = 0.78, 95% CI: 0.64–0.96), retired patients compared with workers, and patients who experienced violence, high falls, traffic accidents, low falls, and non-traumatic injuries compared with patients struck by falling objects had ORs<1 and were therefore more likely to experience incomplete injuries (
Variables | ||
≤20 | 0.83 (0.53–1.29) | 0.410 |
21–40 | 1.08 (0.80–1.47) | 0.630 |
41–60 | 1.04 (0.77–1.41) | 0.780 |
≥61 | 1.00 (reference) | - |
Male | 0.013 | |
Female | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Yes | 0.021 | |
No | 1.00 (reference) | - |
A total of 223 patients' medical records were missing age information.
Variables | ||
Struck by falling objects | 1.00 (reference) | - |
Violence | 0.83 (0.52–1.32) | 0.420 |
High falls | 0.003 | |
Traffic accidents | 0.002 | |
Crushing injuries | 0.33 (0.07–1.52) | 0.157 |
Sports-related injuries | 0.58 (0.19–1.81) | 0.348 |
Low falls | <.001 | |
Non-traumatic |
<.001 | |
Other |
0.015 | |
Married | 1.00 (reference) | - |
Unmarried | 0.002 | |
Divorced | 3.09 (0.93–10.24) | 0.065 |
Widowed | 1.99 (0.41–9.71) | 0.396 |
Unknown | 1.16 (0.14–9.74) | 0.892 |
1.00 (reference) | - | |
Workers | 0.92 (0.74–1.14) | 0.459 |
Peasants | 1.25 (0.73–2.12) | 0.413 |
Unemployed | 0.80 (0.35–1.83) | 0.603 |
Retired | 0.029 | |
Other occupations |
0.71(0.50–1.03) | 0.070 |
Other | 0.71 (0.44–1.15) | 0.167 |
Non-traumatic referred to inflammation, tumors, ossification, degenerative damage, and vascular damage.
Other included low falls, violence, and sports-related injuries.
Other occupations included self-employed people, civil servants, students, and enterprise staff.
Variables | ||
Male | 0.034 | |
Female | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Yes | 0.001 | |
No | 1.00 (reference) | - |
Yes | <.001 | |
No | 1.00 (reference) | - |
Struck by falling objects | 1.00 (reference) | - |
High falls | 0.009 | |
Traffic accidents | 0.007 | |
Low falls | <.001 | |
Non-traumatic | 0.006 |
Depending on the severity of the injury, it was expected that there would be different treatment options for the SCI patients. In this study, the proportions of patients accepting surgery, rehabilitation therapy, traction, and hyperbaric oxygen therapy were 55.4%, 21.7%, 12.8% and 7.2%, respectively. Among the 678 complete SCI patients, there were 407 patients who received a surgical intervention, 187 patients adopting rehabilitation therapy, 154 patients accepting traction, and 61 patients treated with hyperbaric oxygen therapy. The differences in the number of patients accepting surgery, rehabilitation therapy, and traction between the patients with and without complete injury were statistically significant (
Treatment | Severity of injury, n (%) | |||
Complete | Incomplete | Total | ||
0.043 | ||||
Yes | 407 (19.1) | 1718 (80.8) | 2125 (55.4) | |
No | 271 (15.9) | 1436 (84.1) | 1707 (44.5) | |
<.001 | ||||
Yes | 187 (22.5) | 643 (77.5) | 830 (21.7) | |
No | 491 (16.4) | 2511 (83.6) | 3002 (78.3) | |
<.001 | ||||
Yes | 154 (31.3) | 338 (68.7) | 491 (12.8) | |
No | 525 (15.7) | 2816 (84.3) | 3341 (87.2) | |
0.246 | ||||
Yes | 61 (22.2) | 214 (77.8) | 275 (7.2) | |
No | 617 (17.3) | 2940 (82.7) | 3557 (92.8) | |
678 (17.7) | 3154 (82.3) | 3832 (100.0) |
HO therapy = Hyperbaric oxygen therapy.
Treatment | Prognosis, n (%) | |||||
Cured | Improved | Non-cured | Unknown | Total | ||
<.001 | ||||||
Yes | 890 (41.9) | 1116 (52.5) | 74 (3.5) | 45 (2.1) | 2125 (55.4) | |
No | 696 (40.8) | 864 (50.6) | 73 (4.3) | 74 (4.3) | 1707 (44.5) | |
<.001 | ||||||
Yes | 286 (34.5) | 496 (59.8) | 24 (2.9) | 24 (2.9) | 830 (21.7) | |
No | 1300 (43.3) | 1484 (49.4) | 123 (4.1) | 95 (3.2) | 3002 (78.3) | |
0.069 | ||||||
Yes | 214 (43.6) | 241 (49.1) | 26 (5.3) | 10 (2.0) | 491 (12.8) | |
No | 1372 (41.0) | 1739 (52.1) | 121 (3.6) | 109 (3.3) | 3341 (87.2) | |
0.015 | ||||||
Yes | 63 (22.9) | 202 (73.5) | 8 (2.9) | 2 (0.7) | 275 (7.2) | |
No | 1523 (42.8) | 1778 (50.0) | 139 (3.9) | 117 (3.3) | 3557 (92.8) | |
1586 (41.4) | 1980 (51.7) | 147 (3.8) | 119 (3.1) | 3832 (100.0) |
HO therapy = Hyperbaric oxygen therapy.
It is well known that SCI imposes a substantial burden on individuals, their families and society because of the cost of healthcare treatments, rehabilitation and lost productivity. Therefore, the results of this research can support the reasonable allocation of medical resources and the implementation of preventive measures. This study is a retrospective cross-sectional study of the characteristics of the SCI patients in Guangdong, China, from 2003 through 2011. As a retrospective study, it was inevitable that some data might have been lost. The loss of data was minimized by examining all the related medical records to obtain a data set that was as complete as possible. The number of SCIs has displayed a trend of annual growth. The results of the study revealed that the mean age of SCI patients was 42.4±15.3 years, which is in accordance with a 2011 report from Tianjing
Currently, most epidemiological research studies from countries worldwide have focused on traumatic SCIs, and the information about non-traumatic SCIs is limited
China is a rapidly developing country, and Guangdong is a region of China that is undergoing significant economic expansion. Compared with other regions, Guangdong has unique characteristics: a larger population, a higher-level economy than most of China, and more engagement with international community. Until now, epidemiology research about spinal cord injuries in Guangdong, China has been very rare. However, this information is needed to implement preventive measures to control the expansion of the SCI population. First, data must be collected and analyzed to help define the problem and to identify possible risk factors in various populations. Preventive strategies should be targeted at persons who are at the greatest risk for injury, such as young male adults who are engaged in dangerous outdoor work. Second, environmental modifications should be strengthened. Roads should be widened and protective barriers installed between the motor road and the sidewalk to prevent traffic accidents
In summary, although there were some shortcomings, the results of the study were similar to another related study about the epidemiology of spinal cord injuries. The mean age at the time of injury was older, and the proportion of males was higher. The main causes were traffic accidents and being struck by falling objects. Workers, peasants and the unemployed were the high-risk occupational groups. The number of SCI patients has increased annually. The statistical analysis revealed that being male, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete SCI. The treatments were significantly different between the patients with and without complete injuries. All these data indicated that preventive measures should be based on the characteristics of different groups, and public policies aimed at preventing injuries should focus on high-risk populations, such as young males.
We gratefully acknowledge the assistance of the study hospitals for their help in collecting medical records. In addition, we express our thanks to all the participants in the study, without whom the study would not have been possible.