Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years

BackgroundThe objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan.MethodsFrom the claims database of Taiwan National Health Insurance, we identified 6164 adult patients with newly diagnosed SCI with permanent functional disability from 2000 to 2015 and followed them until the end of 2016. We estimated survival function through the Kaplan-Meier method and extrapolated it to lifetime.ResultsFor the SCI cohort, the LE and loss-of-LE were 17.6 and 13.3 years, respectively, while those for SCI with coding of external causes (E-code) were 18.1 and 13.0 years, respectively. For the SCI cohort with E-code, the loss-of-LE of motor vehicle (MV)-related SCI was significantly higher than that of fall-related SCI. In young and middle-aged patients with SCI with E-code, the loss-of-LE of MV-related paraplegia was significantly higher than that of MV-related quadriplegia and fall-related SCI. With a 3% discount rate, the LMC for patients with SCI after diagnosis were US$82 772, while those for patients with SCI with E-code were US$81 473. The LMC and the cost per year for those living with quadriplegia were significantly higher than those for paraplegia in all age groups, possibly related to the higher frequencies of stroke, chronic lung disease and dementia.ConclusionsWe conclude that quadriplegia has a higher impact on medical costs than paraplegia, and MV-related SCI has a higher impact on loss-of-LE than fall-related SCI. We recommend comprehensive SCI prevention be established, including infrastructures of construction and transportation.

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A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00818-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Jason Smith ◽

Omar Bouamra ◽

Lee Wallis ◽

...

Keyword(s):

Spinal Cord ◽

Blood Loss ◽

Injury Severity ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Tension Pneumothorax ◽

Research Network ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Time Critical

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.

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Attachment Style, Social Support, and Coping as Psychosocial Correlates of Happiness in Persons With Spinal Cord Injuries

Rehabilitation Research Policy and Education ◽

10.1891/2168-6653.27.3.186 ◽

2013 ◽

Vol 27 (3) ◽

pp. 186-205 ◽

Cited By ~ 7

Author(s):

Lisa Wilson ◽

Denise Catalano ◽

Connie Sung ◽

Brian Phillips ◽

Chih-Chin Chou ◽

...

Keyword(s):

Social Support ◽

Spinal Cord ◽

Positive Psychology ◽

Attachment Styles ◽

Functional Disability ◽

Spinal Cord Injuries ◽

Negative Relationship ◽

Well Being ◽

Psychosocial Correlates ◽

And Coping

Objective: To examine the roles of attachment, social support, and coping as psychosocial correlates in predicting happiness in people with spinal cord injuries.Design: Quantitative descriptive research design using multiple regression and correlation techniques.Participants: 274 individuals with spinal cord injuries.Outcome Measures: Happiness as measured by the Subjective Happiness Scale.Results: Functional disability and psychosocial correlates including coping, attachment styles, and social support were found to be associated with happiness scores. Functional disability was found to have a large negative effect on happiness and the effect was significantly reduced after taking into consideration the effect of positive psychology factors.Conclusion: Positive psychology variables are important for happiness and subjective well-being, and happiness in turn is related to better quality of life. The negative relationship between functional disability and happiness can be mediated by attachment, social support, and coping. Rehabilitation professionals should deemphasize negative characteristics related to poor psychological adjustment and focus on positive human traits and positive psychology interventions for people with disabilities.

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Emergency Cervical Splints — Their Value and Limitation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00044459 ◽

1985 ◽

Vol 1 (S1) ◽

pp. 197-198

Author(s):

Andrew K. Marsden

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Good Deal ◽

First Aid ◽

Front Seat ◽

Comprehensive Management ◽

General Impression

A good deal of controversy currently surrounds the role of collars and extrication devices in the on-site immobilization of suspected injuries to the cervical spine. The plethora of manufactured items readily available for this purpose reinforces the general impression that no one device is universally acceptable.In his book,Spinal Cord Injuries–Comprehensive Management and Research, Sir Ludwig Guttman stressed the importance of keeping all cervical movements to a minimum. Flexion, hyperextension and rotatory movements are particularly dangerous. The most difficult circumstances are those in which an unconscious front-seat occupant requires extrication from a damaged motor vehicle. Here the strict first-aid drill of gentle lifting by a six man team maintaining rigid traction in the line of the spine becomes impracticable and the rescuers have to resort to the use of aids.

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A Comparison of the Demographics, Injury Patterns and Outcome Data for Patients Injured in Motor Vehicle Collisions Who Are Trapped Compared to Those Patients Who Are Not Trapped

10.21203/rs.3.rs-61529/v1 ◽

2020 ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Jason Smith ◽

Omar Bouamra ◽

Lee Wallis ◽

...

Keyword(s):

Spinal Cord ◽

Blood Loss ◽

Injury Severity ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Tension Pneumothorax ◽

Research Network ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Time Critical

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. Understanding the outcomes and injuries of those trapped following an MVC will help guide meaningful patient-focused interventions and future extrication strategies.Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients who were admitted to an English hospital following an MVC from 2012-2018. Patients were excluded when their outcomes were not known or if they were secondary transfers.Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p<0.001). Spinal cord injuries were rare (0.29% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were not trapped (p<0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10-29) vs 13 (IQR 9-22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow comas Scale, GCS (all p<0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p<0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p<0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for <0.3% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.

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Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13480820 ◽

2021 ◽

pp. CJN.13480820

Author(s):

Yu-Tzu Chang ◽

Fuhmei Wang ◽

Wen-Yen Huang ◽

Hsuan Hsiao ◽

Jung-Der Wang ◽

...

Keyword(s):

Life Expectancy ◽

Kidney Failure ◽

Linear Models ◽

Comprehensive Evaluation ◽

Survival Function ◽

Sensitivity Analyses ◽

Research Database ◽

Loss Of Life ◽

Lifetime Employment ◽

Employment Duration

Background and objectivesAn accurate estimate of the loss of lifetime employment duration resulting from kidney failure can facilitate comprehensive evaluation of societal financial burdens.Design, setting, participants, & measurementsAll patients undergoing incident dialysis in Taiwan during 2000–2017 were identified using the National Health Insurance Research Database. The corresponding age-, sex-, and calendar year-matched general population served as the referents. The survival functions and the employment states of the index cohort (patients on dialysis) and their referents for each age strata were first calculated, and then extrapolated until age 65 years, where the sum of the product of the survival function and the employment states was the lifetime employment duration. The difference in lifetime employment duration between the index and referent cohort was the loss of lifetime employment duration. Extrapolation of survival function and relative employment-to-population ratios were estimated by the restricted cubic spline models and the quadratic/linear models, respectively.ResultsA total of 83,358 patients with kidney failure were identified. Men had a higher rate of employment than women in each age strata. The expected loss of lifetime employment duration for men with kidney failure was 11.8, 7.6, 5.7, 3.8, 2.3, 1.0, and 0.2 years for those aged 25–34, 35–40, 41–45, 46–50, 51–55, 56–60, and 61–64 years, respectively; and the corresponding data for women was 10.5, 10.1, 7.9, 5.6, 3.3, 1.5, and 0.3 years, respectively. The values for loss of lifetime employment duration divided by loss of life expectancy were all >70% for women and >88% for men across the different age strata. The sensitivity analyses indicated that the results were robust.ConclusionsThe loss of lifetime employment duration in patients undergoing dialysis mainly originates from loss of life expectancy.

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