Spinal cord injury etiology, severity, and response to care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project

Abstract Study Design: Cross-sectional study. Objectives: To determine etiologic factors related to spinal cord injury (SCI) severity and to assess factors related to benefit from care in individuals seen for SCI in six Eastern and South-eastern Asian countries. Setting: Care centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand. Methods: Data from multiple centers collected between October 2015 and February 2021 were analyzing using descriptive statistics and logistic regression. Results: Among 2,634 individuals, the leading cause of SCIs was falls (n=1410, 54%). Most single-level SCIs occurred in the thoracic spine (n=977, 39%). Greater than half of SCIs (n=1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n=757) of all single-level AIS A SCIs, and the percentage of thoracic SCIs graded AIS A (78%) was significantly higher than cervical (51%), lumbar (24%), sacral (8%), and multiple level (15%) SCIs (p<0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted injury severity: age, spinal region, injury etiology, and country of residence. Four factors also predicted inpatient improvement: age, spinal region, AIS grade on intake, and country of residence. Conclusions: Falls were the leading cause of traumatic SCIs, most of which occurred from ≥1 meter. The thoracic spine was the most commonly injured region, and thoracic SCIs were associated with both increased injury severity and poorer recovery. Age, spinal region, and country were each predictive factors of both SCI severity and inpatient improvement. Sponsorship: Mayo Clinic Global Health Program