Actionable Nuggets for SCI (2nd ed., 2013)
Be aware of the most important health risks for patients with spinal cord injuries.
If you have someone in your practice with a spinal cord injury (SCI), it will be important for you to understand the most common health issues that are bring people with SCI into contact with family medicine. Spinal cord injury is a low-prevalence, but a high-impact condition, and patients with spinal cord injuries depend on their family physician to recognize important health problems and treat them aggressively. This series of post cards is designed to help you with that. This first one offers an introduction to the epidemiology of spinal cord injury.
Evidence-based Best Practice:
The incidence of spinal cord injury in Canada is estimated between 3-5/100,000 population. Several studies report a bimodal distribution of age at onset, with peaks in the 3rd and 8th decades. Onset may be traumatic (~40%; auto collisions, falls) or non-traumatic (~60%; tumours, neurological conditions). Prevalence estimates vary between 40-80,000 including both traumatic and non-traumatic lesions; therefore the average family practice will typically have only 1 or 2 patients with SCI.
Although survival has increased significantly in recent decades, people with SCI still have life expectancies several years less than their non-disabled contemporaries, depending on the severity and completeness of disability. The most common cause of death is no longer renal failure; currently respiratory and cardiovascular complications, such as pneumonia and septicemia, contribute to premature mortality. An increasing number of people with SCI die of the same causes as the general population: cancer or cardiovascular disease. Suicide risk is significantly higher among patients with SCI. Factors affecting survival include: duration and severity of disability, poverty, fracture/surgery, depression, substance abuse.
In addition to the usual health concerns associated with aging (hypertension, diabetes, infectious disease), patients with SCI experience excess morbidity from secondary complications, such as pain, pressure ulcers, urinary tract infections, bowel problems, autonomic dysreflexia, depression. The remaining “Nuggets” focus on the most common secondary complications seen in primary care, and the knowledge needed by family physicians to provide excellent care for these patients.
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