Fatal cervical spine injuries: a Finnish nationwide register-based epidemiologic study on data from 1987 to 2010

Abstract

Background context: The number of cervical spine injuries (CSIs) is increasing. Cervical spine injuries are associated with high morbidity and mortality. Identifying those who are at risk for CSI-related death can help develop national and international interventions and policies to reduce mortality.

Purpose: This study aimed to determine the trends in the incidence and the characteristics of fatal CSIs in Finland over a 24-year study period from 1987 to 2010.

Study design/setting: A large nationwide, retrospective, register-based study was carried out.

Patient sample: The population-based sample was collected from death certificates issued in Finland between 1987 and 2010. The death certificates were obtained from the official Cause-of-Death Register, coordinated by Statistics Finland, which covers all deaths occurring in Finland.

Outcome measures: Sociodemographics and injury- and death-related data were used for outcome measures.

Methods: All death certificates issued in Finland (1987-2010) containing a CSI as the cause of death were carefully reviewed.

Results: A total of 2,041 fatal CSIs were identified. These constituted 0.17% of all deaths in Finland within the study period. The average annual incidence of fatal CSIs was 16.5 per million (range: 12.5-21.2). The majority of the victims were male (72.9%) and had concurrent spinal cord injury (83.0%). Traffic accidents (40.1%) and falls (45.0%) were the most common injury mechanisms. Almost one-third (29.8%) of the deaths were alcohol-related. Among the young victims (<60 years) with upper CSI (C0-C2), the majority (91.8%) died within 24 hours post-injury. One-third of elderly victims' (≥60 years) CSI-related deaths occurred after 1 week post-injury and were mostly (74.2%) caused by respiratory and circulatory system diseases. Within the 24-year period, the incidence of fatal CSIs (+2/million), as well as the average age of sustaining a fatal CSI (+13.5 years), increased markedly. Fall-induced accidents among elderly males were the most prominently increasing subpopulation of fatal CSI victims.

Conclusions: In recent decades, fatal CSI incidence (death certificate-based) has increased, being 18.6 per million in Finland in 2010. Victims of fatal CSIs tend to be older than in the past, and for a substantial number of males, low-energy falls lead to cervical trauma and death.

Keywords: Autopsy; Epidemiology; Mortality; Registries; Spinal cord injuries; Spinal injuries.