Trends in spinal cord injury.

This study reports on trends in spinal cord injury based on the Australian Spinal Cord Injury Register (ASCIR), which provided full coverage in those aged 15 years and over. The underlying annual rate of change from 1986 to 1997 was calculated for age-specific, crude and age-standardised incidence rates. An appropriate model for this type of data was the Poisson regression model, with a Poisson error distribution, a log link function and the natural log of population treated as an 'offset'. It was found that there was no change in the age-standardised rate of spinal cord injury. However, an assessment of specific rates by age, sex, cause and neurological group revealed some contrasting trends, notably declining rates in young males, transport-related injury and complete tetraplegia, and increasing rates in elderly males, fall-related injury and incomplete tetraplegia and complete paraplegia. These changes are considered to reflect the impact of a raft of public health measures directed at transport-related injury but a paucity of prevention programs directed at fall-related spinal cord injury. More research is required to determine the causes of the increasing rate of elderly male fall-related spinal cord injury. There is also more that can be done to prevent transport-related spinal cord injury. Sport utility vehicles pose an increased concern. In order to reinvigorate the debate about the need for a vehicle rollover resistance rating in Australia, the spinal cord injury risk of different models of SUV should be measured. This has already been implemented in the United States, providing the public with information to assist purchasing based on safety considerations.