Since 1977 the Arkansas Spinal Cord Commission (ASCC) has maintained a registry of residents with spinal cord disability. The registry is used to identify persons who are eligible to receive ASCC services.

Medical Criteria: To be included on the registry, an individual must have incurred damage to the spinal cord by trauma, infection, tumor, disease, developmental defect or degenerative disorder. In addition, the severity of the damage must result in lack of normal function in three (3) of four (4) areas: paralysis, sensation, bladder control and bowel control. As a result of applying the medical criteria, persons with spinal cord injury (SCI) placed on the registry generally have permanent injuries and are severely affected.

Incidence: For the 2000-2003 three year time period, a mean average of 97.5 spinal cord injury (SCI) cases were added to the registry each year. This is an annual rate of 36.0 SCIs per million population using 2002 population estimates. The Arkansas incidence rate is lower than other states due to the more restrictive medical criteria that ASCC uses for inclusion on the registry.

Prevalence: As of June 2004 there were 1328 persons living with spinal cord injury in Arkansas on the registry. A descriptive analysis of these 1328 persons follows.

Age at injury: Spinal cord injuries are mainly incurred by young adults. More than half (53.5%) of all SCIs occur to persons between the ages of 16 to 30. Persons age 15 and under account for 5.8 percent of all SCIs; age 31 to 40, 19.5 percent; 41 to 50, 12.6 percent; and age 51 and over, 8.6 percent.

Gender: Males constitute 80.0 percent of all spinal cord injuries.

Race: Whites makeup nearly three-fourths (73.4%) of all SCIs in Arkansas; African Americans, 24.6 percent and all others, 2.0 percent. Persons of Hispanic ethnicity constitute 1.1 percent of all spinal cord injuries.

Etiology: Almost half (49.0%) of SCIs in Arkansas are due to motor vehicle crashes. Violence, mainly gunshot, is the second leading cause at 17.9 percent, falls are next at 12.2 percent, followed by sports at 7.4 percent and all other causes 13.5 percent.

The SCI etiology breakdown for males, since they constitute 80 percent of all SCIs, is very similar to the total population. Females, however, sustained more of their injuries by motor vehicle crashes (61.3%) and fewer by falls (7.5%) and sports (0.8%).

Whites are similar to the etiology breakdown of the total population except that fewer of their injuries were caused by violence (9.0%) and slightly more by motor vehicle crashes (54.4%). For nonwhites the primary cause of SCI is violence (42.5%) followed by motor vehicle crashes (34.3%).

Alcohol Involvement: At the time of injury, there was evidence of alcohol intoxication or the injured person tested above the legal blood alcohol limit in 22.4 percent of the cases. In 20.0 percent of all cases there was another person who played an active part in the injury situation, such as, a driver of another vehicle who was intoxicated. Thus, alcoholic impairment plays a major role in the cicumstances surrounding SCI.

Neurological Level and Extent of Lesion: Injury to the cervical area of the spinal cord results in tetraplegia (40.8%); injury to the thoracic, lumbar or sacral areas of the cord result in paraplegia (59.2%). Tetraplegic injuries are more severe than paraplegic injuries.

Individuals who have lost all motor and sensate ability below the level of injury are termed complete (48.7%). Those individuals who have retained some motor or sensate ability below the level of injury are termed incomplete (51.3%). Complete injuries are more severe than incomplete injuries at a given level of injury.

Employment Status: At the time of their injury, 57.2 percent indicated that they were working full or part time. An additional 14.5 percent were students; unemployed but of working age made up 11.1 percent; child or infant 9.1 percent; retired 4.2 percent; homemaker 2.8 percent and all others 1.1 percent.

Work Related: Only 15.5 percent of the injuries were work related.

Education: High school graduates made up 38.2 percent of SCIs at the time of injury. Some high school but no diploma 30.1 percent and just elementary school 9.5 percent. Some had attended college but did not have a degree 14.1 percent; and some attended college and had a degree 6.9 percent. A few persons were not of school age at time of injury 1.2 percent.

State Where Injured: Most (81.0%) of the injuries occurred in Arkansas.

Primary Payment Source: For the years 2000 to 2003, the primary payors for the initial SCI acute care hospital cost were insurance plans (39.0%), Medicaid (35.0%), Medicare (13.0%), Worker’s Compensation (5.7%), self pay (4.5%) and all other sources (2.8%).

Acute Care Average Length of Stay: For 2000 to 2003, the average length of stay in an acute care facility for the initial hospitalization after SCI was 30 days.

Rehabilitation Average Length of Stay: For 2000 to 2003, the average length of stay in a rehabilitation facility for the initial hospitalization after SCI was 46 days.

Discharge Disposition: A person with an SCI is typically admitted to an acute care hospital for treatment. Depending on the severity of the injury, an individual may be discharged home, to a residential living facility or to a rehabilitation hospital. Most (78.4%) are discharged to a rehabilitation hospital. After rehabilitative care, an individual may again be discharged to home, a residential facility or for additional acute or rehabilitation care.

The discharge disposition for persons injured from 2000 to 2003, after their initial acute and rehabilitative care, is:

13.5% - Acute/Rehab Facility
21.0% - Home, self care
38.4% - Home, non-skilled care
17.4% - Home, skilled care
00.9% - Residential facility, non-skilled care
07.9% - Residential facility, skilled care
00.9% - Other

Thus, over three-fourths (76.8%) of persons with spinal cord injury were able to return home after their initial hospitalization for acute and rehabilitative care.

Cost: The health care costs for the initial hospitalization and for lifetime living expenses associated with SCI are enormous. These costs vary greatly with severity of injury and age at injury.

Although ASCC does not track overall financial costs, the Model Spinal Cord Injury System (MSICS) has estimated these costs. MSICS estimates first year expenses range from $184,662 to $626,588. Subsequent yearly expenses range from $12,941 to $112,237. Estimated lifetime costs for a person 25 years old, at time of injury, range from $533,474 to $2,393,507. A 50 year old person, at time of injury, ranges from $386,619 to $1,409,070.

Return to Work: Most persons with a spinal cord injury do not return to work or enter the work force after being injured. In a major 1996 study of 650 persons with SCI, ASCC found that 76.1 percent did not return to work or school after injury.

Secondary Conditions: Persons with SCI are more apt to develop secondary conditions or medical complications that are more likely to occur because a person has a SCI. In 1996 ASCC found these secondary conditions to be most frequently cited among 650 persons with SCI:

86.9% - Changes in sexual functioning
83.7% - Spasms
62.9% - Depression
62.0% - Chronic pain
55.1% - Urinary tract infection
47.6% - Fatigue
40.2% - Limitations in range of motion
37.2% - Pressure sores
35.3% - Fractures
32.5% - Pneumonia
30.2% - Hemorrhoids
28.9% - Autonomic dysreflexia

Life Expectancy: On average, an individual with SCI has a reduced life expectancy compared with persons without a spinal cord injury. MSCIS has estimated life expectancy by severity and age of injury. A paraplegic, who was 20 years old at the time of injury and is one year post-injury, can expect to live another 46.0 years; a 40 year old at time of injury, 28.3 years; and a 60 year old at time of injury, 13.2 years.

A low level (C5-C8) tetraplegic, who was 20 years old at the time of injury and is one year post-injury, can expect to live another 41.8 years; a 40 year old at time of injury, 24.7 years; and a 60 year old at time of injury, 10.7 years.

A high level (C1-C4) tetraplegic, who was 20 years old at the time of injury and is one year post-injury, can expect to live another 38.2 years; a 40 year old at time of injury, 21.8 years; and a 60 year old at time of injury, 8.8 years.

Cause of Death: Many medical advances have been made in the care of persons with spinal cord injury over the last 40 years. Whereas a large percentage of persons with SCI did not survive in years past, individuals today can expect to live close to a normal life span. The major causes of death today are respiratory diseases (22.0%), heart disease (20.6%), external causes (16.0%), cancer (11.0%), septicemia (9.8%) and all other causes (20.6%).

References

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (1993). Acute, Traumatic Spinal Cord Injury, United States, 1990-1991. Atlanta, GA.

DeVivo, M. J., Krause, J. S., Lammertse, D. P. Recent Trends in Mortality and Causes of Death Among Persons with Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation. Vol. 80, November, 1999.

National Spinal Cord Injury Statistical Center. (2003). Spinal Cord Injury Facts and Figures at a Glance. Birmingham, AL.

Vines, C. L., Maness, J. E., Farley, T. L., McCluer, S., Myrick R. S., et al. (1996). Identifying Secondary Conditions in Arkansans with Spinal Cord Injuries. Little Rock, AR: Arkansas Spinal Cord Commission.