The incidence and prevalence of persons with spinal cord injury is on the rise 1. The rising tide of this physical health condition globally has been associated with an increase in motor vehicle injuries and crime- related cases. What is, however, different in the developing world, with South Africa as the focal point, is the significant number of spinal cord injuries caused by acts of violence 2. Although the health profile of South Africa is thought to be undergoing a noteworthy transition and that a dearth of knowledge on the incidence and mortality of spinal cord injury in South Africa is persisting, it is postulated that the socio-economic- and political climate are the main determinants of ensuring unfavourable conditions for the significant reduction of this highly disabling health condition. Therefore, crime related injuries are remaining a major problem and exception to the local context 3. The increase in spinal cord injury in both the national-and international contexts greatly impacts not only the individual with the injury, but also the immediate family for the provision of support and the National Government for the provision of long-term health care and financial support 4. Given these assumptions and empirical evidence, it is essential to investigate various aspects of the epidemiological profile of spinal cord injury in order to plan and implement appropriate health care interventions and disease prevention strategies. The aim of this study was to contribute to the global map of TSCI epidemiology using a prospective, population-based approach to estimate the incidence rate and to determine the main causes and injury characteristics of survivors in the City of Cape Town region, South Africa. Further, this study will assist in creating an evidence-based foundation for primary and secondary prevention of TSCI and its associated consequences. Methods Conclusions Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa JS Phillips 1 & C Joseph 2 1. University of the Western Cape, South Africa 2. Karolinska Institute, Stockholm, Sweden Figure 1: Aetiology of traumatic spinal cord injury for different age categories Figure 2: Location and severity of injury Bibliography CHART or PICTURE Setting and implementation of active registration system The study was conducted in the City of Cape Town region, which is situated in the Western Province of South Africa. The catchment is most diverse with regard to socioeconomic status and ethnicity, and consists of urban and peri- urban areas. The population, at the end of 2013, was estimated at 3.86 million and is spread across an area of 2445 km 2. The region is most inhabited by Coloured people (mixed race origin), comprising 42.4% of the population, followed by Africans representing 38.6%, Whites contributing 15.7% to the population, and the remaining 1.3% belonging to the Indian/Asian ethnic group. A specialized acute SCI unit is situated in the City of Cape Town region, serving people in the Western Cape Province of South Africa. In the government-funded healthcare system, the SCI care is provided in a systematic manner with survivors receiving care at Groote Schuur Hospital acute SCI unit and specialized rehabilitation at another facility situated in Cape Town. However, due to limited resources at the acute SCI unit, patients are accepted on a referral basis. In order to maximise the coverage to all survivors of TSCI, other non-specialized, referring hospitals in the catchment area that were responsible for their management, either for an interim period (until a placement became available at the specialized unit) or for the entire acute management period, were included. Thus, the registration system for TSCI included the screening of cases at the specialized acute SCI unit at Groote Schuur Hospital, the other tertiary hospital (Tygerberg), and referrals that were received from three secondary hospitals. Data collection and procedure The instrument for data collection consisted of the International SCI Core Data Set, as recommended by the members of the Executive Committee for the International SCI Data Sets Committees 5. Variables included, date of birth, gender, date of injury, date of acute admission and discharge (duration of hospital stay), aetiology, presence of vertebral fractures and associated injuries, whether spinal surgery was performed, ventilator-dependence at discharge, and place of discharge. Assessment of neurological severity was done according to the International Standards for Neurological Classification of Spinal Cord Injury 6. Two attending specialist doctors completed the International SCI Core Data Set for all admitted patients.. 1.Hagen EM, Rekand T, Gilhus NE, Grønning M. Traumatic spinal cord injuries- incidence, mechanisms and course. Tidsskr Nor Legeforen 2012;132: Hart C, Williams E. Epidemiology of spinal cord injuries: a reflection of changes in South African society. Paraplegia 1994;32: Connor M, Bryer A. Stroke in South African. Chronic diseases of lifestyle in South Africa: (2006). Technical Report. Steyn, K, Fourie, F., & Temple, N. Cape Town, South Africa. South African Medical Research Council. 4.Pickett GE, Campos-Benitez M, Keller JL, Duggal N. Epidemiology of traumatic spinal cord injury in Canada. Spine 2006; 31(7): DeVivo MJ, Biering-Sorensen F, Charlifue S, Noonan V, Post M, Stripling T et al. International spinal cord injury core data set. Spinal Cord 2006; 44:535– Waring WP III, Biering-Sorensen F, Burns S, Donovan W, Graves D, Jha A et al Review and revisions of the international standards for the neurological classification of spinal cord injury. J Spinal Cord Med 2010; 33: 346– Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW et al. The epidemiology of traumatic spinal cord injury in Alberta, Canada. Can J Neurol Sci 2003; 30: 113– Draulans N, Kiekens C, Roels E, Peers K. Etiology of spinal cord injuries in Sub-Saharan Africa. Spinal Cord 2011; 49: 1148–1154. Table 1 Traumatic spinal cord injury incident cases, age and gender-specific incidence rates (per annually) with 95% confidence intervals (CIs) for males, females and total population in City of Cape Town Age groups n Rate males 95% CI n Rate females 95% CI P value* n Rate total 95% CI _______________________________________________________________________________________________________________________ 18– – –53.7 < – – – –40.2 < – – – –42.8 < – – – – – – – –65.7 _______________________________________________________________________________________________________________________ * Differences were considered significant at P=0.05. Study population and characteristics Overall, 147 individuals sustained a TSCI during the study period. Of the 145 consented cases, 124 (85.5%) were males, and the male to female ratio was 5.9:1.The mean age at injury was 33.5 (SD=13.8) ranging between 18 and 93 with 54%and 6% of the cohort in the and >60 categories. Incidence The annual crude incidence rate of TSCI for this population was 75.6 per million persons. The gender specific incidence rates were and 21.2 for males and females respectively. Aetiology The main cause of injury in this study was assault (59.3%), followed by transportation (26.3%) and falls (11.7%). Location and severity Spinal injury to the cervical area (C1-8) was most common (53.1%), followed by injuries in the thoracic area (38.6%). Fifty-seven (39.3%) of the participants were motor-sensory complete (AISA) with the highest proportion of those having thoracic spinal injuries (55.4%) The first prospective, population-based study in the City of Cape Town, South Africa, revealed a high incidence of TSCI that occurred predominantly in males between the ages of 18 and 29 years and chiefly due to interpersonal violence (assault). The annual crude incidence of TSCI was 75.6 per million for the population under study, which was found to be among the highest in the world and comparable to estimates of 60.6 per million in China and 52.5 per million in Canada 7. The global incidence rate was estimated to be 23 cases per million, with the highest in North America (40 per million) and an interval for Africa ranging between 21 and 29 per million.6 The results of this study suggested a much higher incidence of TSCI in South Africa than previously estimated. Almost 60% of the TSCIs were caused by assault. In this study, the assault category comprised gunshots, stabs and blunt trauma. It was the leading cause for both genders, suggesting similar preventative needs. More than half of the assault cases were firearm related. The proportion of gunshot and stab wounds appears to be a unique problem in South Africa compared to other African countries 8. Introduction Results