Bulletin 21 - Trends in persisting cases of SCI
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Trends in persisting cases of SCI
The assessment of the rate of persisting cases of SCI in 1997/98 was
affected by missing admission and discharge information for 14 cases. Given
that a neurological deficit is the predominant outcome of SCI cases referred to
SUs, these 14 cases were included as persisting cases with an age distribution
matching that of the reported cases. This enabled a national age adjusted rate
to be estimated using direct standardisation, taking the Australian population
in 1991 as the standard.
The age adjusted incidence rate of persisting cases of SCI in 1997/98 was estimated to be 15.2 per million of population, an increase from 1996/97 (13.2 per million of population). The case count (n=278) was the highest recorded over the eight-year period for which reliable annual data was available, being 40 cases higher than the average yearly figure for the combined years 1986-1990, 1995/96 and 1996/97 (average=238 cases per year). The case count for Western Australian residents more than doubled from 1996/97 to 1997/98 (from 23 to 47 cases, respectively). This increase was cross checked, by examination of individual records for 1996/97 and 1997/98, and validated by medical and ancillary staff, and was indeed found to be a real increase (although a few cases initially identified as persisting cases at the time that this report was prepared, were subsequently found to have been discharged normal or very incomplete when this special audit was conducted). The increase was not attributable to any single cause but tended to be greater for some demographic
groups than others. It is difficult to know what factors are behind the increase. A planned future analysis of State trends in SCI from 1986 may throw some light on the year to year fluctuations noted for Western Australia, this year, and for other States, in previous years.
Considering that the estimated cost of the long term care of SCI ranges from about $600,000 for a paraplegic to more than $4 million for a ventilator dependent tetraplegic4, the increase in SCI nationally represents the potential for a substantial cost increase.
| Figure 1 shows the age adjusted rate of persisting cases of SCI for 1997/98
with the rates for earlier years. It is evident that there have been year to
year fluctuations in the rate of SCI over the period, with no consistent trend
being apparent. A more complete assessment of trend will be undertaken when
data for the period 1991 to mid-1995 is made available by all SUs, as agreed
during the 1998 meeting of the International Medical Society of Paraplegia
(IMSOP) Australasian Branch.
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Figure 1: Incidence of persisting SCI from traumatic causes by year, Australia 1997/98 (age adjusted rates)
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4 Walsh J and De Ravin JW. Long term care - disability and ageing. The Institute
of Actuaries of Australia, Session Meeting 1995, October/November 1995.
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