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An Evaluation of Spinal Cord Injury (SCI)Associated with Motor Vehicle Crashesincluding RolloversEileen Bulger, MDRobert Kaufman, BSChris Mack, MSStephen Burns, MDUniversity of Washington
Traumatic Spinal Cord Injury 11,000 new cases annually in US 260,000 persons in US living with chronic SCI Primary data source: National SCI StatisticalCenter– non-random sample of US SCI cases treated at 14 SCIModel Systems– Summary of data at:http://www.spinalcord.uab.edu/show.asp?durki 21446
Neurologic Classification Injury Level– Lowest cord level unaffected by SCI Completeness of injury– Complete injury (50% of all injuries): no motor or sensorysignals pass through the injured segment– Incomplete injury: some signals pass Some sensation below injury level May have some motor below levelGreater impairment (higher level; complete injury) causesgreater disability, more medical complications, andreduced life expectancy
Etiology: 2000-2005Other7%% Vehicular 0Falls24%OtherVehicular10% source: National SCI Statistical Center73-79 80-84 85-89 90-94 95-99 00-05
Vehicular Etiology:Level of InjuryOther/Unk.IncompleteParaCompleteT etraCompletePara source: National SCI Statistical CenterIncompleteT etra
Case with Most Common Attributes 19 y/o white male; autocollision C4-C5 vertebralfracture-dislocation C5 neurological level;complete injury (lossall movement andsensation below thatlevel)
Level of Injury About 50% have tetraplegia (quadriplegia):impairment of upper and lower limbsC-SpineT-SpineL-Spine% of patients
% of all injuriesAge at Injury:Vehicular Etiology504540353025201510500-1516-3031-4545-60Age at injury (years)Source:National SCI Statistical Center61-75 75
Course of Care Acute care:– Operative treatment of spinal fracture (66%)– Medical complications (respiratory failure, pneumonia,DVT, pressure ulcers, UTI’s)– Mean LOS: 15 days Rehabilitation– Inpatient: Mean LOS: 40 days– Outpatient therapy Life-long care for secondary medicalcomplications of SCI
Yearly Expenses and Lifetime CostsPer Patient (In 2006 US time (ifinjury age 25)C1-C4 741,425 132,807 2,924,513C5-C8 478,782 54,400 1,047,189Paraplegia 270,913 27,568 977,142 Includes health care expenses and living expenses directly attributable toSCI. Excludes indirect costs such as lost wages, benefits, productivity ( 59,212per year).Source:National SCI Statistical Center
80Life expectancy (additional years)70Life Expectancy forPersons with SCI whoSurvive at Least OneYear Post-injury60504030No SCI20C5–C8, AIS A–C1000204060Age at InjurySource:National SCI Statistical Center80
Life expectancy (additional years)8070Life Expectancy forPersons with SCI whoSurvive at Least OneYear Post-injury60504030No SCIAny Level, with Minimal Paralysis (AIS D)20Paraplegia, AIS A–CC5–C8, AIS A–CC1–C4, AIS A–C10Any Level, Ventilator-Dependent001020304050Age at InjurySource:National SCI Statistical Center607080
Important Medical Complications ofChronic SCI Mortality– Pneumonia, sepsis Morbidity– Pressure ulcers, UTI’s QOL– Bladder, bowel, sexual dysfunction, pain
Seattle CIREN Research“Spinal Cord Injury and Auto Crashes:Findings from Three United StatesDatabases” – submitted ? .Stephen P. Burns, MD, Christopher D. Mack, MS,Robert P. Kaufman, BS, and Eileen Bulger, MD
Databases with SCINSCID CDS –(’93-06) CDS(’93-06) CIREN(’93-05) (unweighted)(’96-06)# of CasesAnnual # ofCases3014 370084346,539 3300163
Databases with SCINSCID(’93-05)CDS –(’93-06) CDS Age, mean (years)35.139.141.339.7Acute Care- LOS, mean 3Neurologic ClassificationTetraplegia (%)Paraplegia (%)Complete (%)50.059.347.144.2Incomplete (%)48.836.746.151.51.23.96.74.3Transient Paralysis (%)
PDOF and ASI-SCIPDOF CategoryNon Horizontal(rollover)Near SideFar SideFrontBackSource: NASS-CDSOccupants withASI (%)2.519Occupants withSCI (%)0.2520.9620.7640.6210.4580.1160.0900.0510.067
SCI in Rollover Collisions
Rollovers and Body TypeRollover TypeNone1/4 turn1/2 turn or greaterCar/Van/Other (%)95.030.774.20SUV/Pickup (%)81.604.0614.34LTV body types were 3.7 times more likely to experienceany degree of a rollover (1/4 turn or greater)Source: NASS-CDS
Rollover Types with ASI-SCIASI (%)SCI (%)None1/4 turn1/2 turn or rSUV/Pickup0.6170.8620.0640.086Rollover TypeVehicle Body TypeSource: NASS-CDS includes those in multiple crash events
Roof Crush and ASI-SCI8Percentage of Occupants with ASI or SCI765ASISCI43210None3-8 cm8-15 cm15-30 cmRoof Crush30-45 cm45-60 cm 60 cm
Other relatedresearch Outside of Arc, more severe injuries/death– Jehle D, Kuebler J, Auinger P. Risk of injury andfatality in single vehicle rollover crashes: danger forthe front seat occupant in the "outside arc". AcadEmerg Med 2007;14:899-902. Roof was main contact points for severe headand neck injuries.– Hu J, Lee J, Yang K, King A. Injury patterns andsources of non-ejected occupants in trip-overcrashes: a survey of NASS-CDS database from1997 to 2002.
Roof Crush and SCICompression - FlexionCompression - ExtensionCompression – Lateral Bending
CIREN Case Reviewswith ASI & SCI
Rollover CIREN Case Reviewswith ASI-SCI1NGLAZINGDEBRIS11CM 2.5MDEEPPOTHOLEMOUNDLIGHT POLE RPNORTH EDGE OFSIDESTREET - RL1PAVED SIDESTREET2000 Sport Utility Vehicle
Front Right PassengerLap/shoulder restrained20’s yrs. – Male(A belt restrained driver, and two other belt restrained passengers insecond row had minor injuries and did not qualify for CIREN criteria)
InjuriesAIS 2 – HeadAIS 4 – C-spine fractures and SpinalCord Injury
Case Review2006 Large VanDriver - 50 yr. old, MaleLap/Shoulder belt restrained(Also front right restrained passenger with minor injury)
Roof Crush and Intrusion40cm/16inches roof Intrusion into driver position
Contacts
Compression- Flexion
InjuriesAIS 1 – HeadAIS 3 – Multiple C-spine fractures
Case Review2003 Compact Pickup TruckDriver – 24 year old MaleLap/shoulder restrained – Air bag deployed(No other passengers in vehicle)
Roof Crush
Driver Seat Position - IntrusionRoof Intrusion over driver 23 cm / 9 inches
Head Contacts
InjuriesAIS 1 –HeadAIS 5 – C-spine fractures and SpinalCord Injury
Assessment of Costsdue to SCI in Rollovers
Yearly Expenses and Lifetime CostsMatched to AIS me (ifinjury age 25)C1-C4 741,425 132,807 2,924,513C5-C8 478,782 54,400 1,047,189Paraplegia 270,913 27,568 977,142Source:National SCI Statistical CenterA.I.S.SCI codes
Annual Costs of SCI for All CrashesSource: NASS-CDS – Nationally all crashes involving SCI
Percent SCI by Roof CrushAmong RolloversMean # of Qtr. Turns4.44.23.94.63 8cm8 15cm15 30cmRoof CrushSource: NASS-CDS 1993-200630 cm
Percent SCI by Roof CrushAmong Rollovers by Body TypeSource: NASS-CDS 1993-2006
Percent SCI by Roof CrushAmong Belted Occupants3 8cm8 15cm15 30cmRoof CrushSource: NASS-CDS 1993-200630 cm
Mean Cost for SCI per Roof Crushfor Belted OccupantsMean Cost per Person 4,500 4,000Cost per Person 3,500 3,000 2,500 2,000 1,500 1,000 500 0 3 cm3-8cm8-15cm15-30cm30 cmMax Roof CrushSource: NASS-CDS – Note: under count due to unknown restraint use for many
Minimize Roof Crush and SavingsMean Cost per Person 4,500 4,000 3,500Cost per Person If roof crush were nohigher than 30cmthen total savings of 717,570,000(1993-2006) Annual Savings 51,255,000 3,000 2,500 2,000 1,500 1,000 500 0 3 cm3-8cm8-15cmMax Roof CrushNote: For belted occupants and undercount due tounknown restraint use for many15-30cm30 cm
Thank you
Matched to AIS coding Injury Severity First Year Subsequent Years Lifetime (if injury age 25) C1-C4 741,425 132,807 2,924,513 C5-C8 478,782 54,400 1,047,189 Paraplegia 270,913 27,568 977,142 Source: National SCI Statistical Center A.I.S. SCI codes
