The Incidence of Paraplegia and Quadriplegia
Hector W. Kay
In 1968, Gehrig and Michaelis (Gehrig, R., and L. S. Michaelis, Statistics of acute paraplegia and tetraplegia on a national scale. Switzerland 1960-1967. Paraplegia 6:93-95, August 1968) published a report on "Statistics of Acute Paraplegia and Tetraplegia on a National Scale." The nation that had been selected for study was Switzerland-a small and highly organized country. Two assumptions were to be tested: 1) that the number of cases of traumatic paraplegia and tetraplegia had increased in recent years; 2) that in planning treatment facilities and programs, ten new cases of traumatic paraplegia or tetraplegia per million population could be anticipated each year.
Since these matters are also of concern to those involved in treatment and rehabilitation programs in the U.S.A., the results of a study which encompassed an entire country are of particular interest.
In the Swiss study it was found that, for the years 1960 through 1967, new cases increased at an average rate of 4 per cent per annum against an average population increase of 2.3 per cent. These new cases represented an incidence of approximately 15 patients (ten paraplegics, five tetraplegics) per million of the total population. An additional two to three cases/million of nontraumatic paraplegics were estimated. Extrapolated to America's 200,000,000 population these data yield a figure of better than 3,000 total new traumatic cases (1,000 tetraplegics, 2,000 paraplegics) per year, plus 450-550 nontraumatic paraplegics.
Despite the care with which the Swiss study was done-all 65 hospitals indicating that they had treated cases of paraplegia or tetraplegia were visited by one of the authors-the reported data must be considered as representing minimal and possibly understated figures. This assumption is based on the fact that the 65 responding institutions represented only slightly more than 25 per cent of the 240 hospitals in the country. It would seem reasonable that a larger number of hospitals would have seen at least one or two paraplegics and tetraplegics.
The cause of accidents in the Swiss study were given as: road traffic 36 per cent, work incidents 35 per cent, home and sport 29 per cent. Of the last group one third was due to attempted suicide, one third to diving accidents, and one third to miscellaneous causes. The age group most affected was the 20- to 29-year-olds (29 per cent). One fifth of the cases was below the age of 21 years. Aside from the attempted suicides, perhaps, these causes would appear to apply equally well in the U.S.A.
It would appear reasonable to extrapolate the results of the nationwide Swiss study on paraplegia and tetraplegia to the American situation. Such an extrapolation would indicate that a large and progressively increasing number of new cases can be expected to appear for treatment each year. The validity of these calculations should be tested since, if true, the findings have profound implications in terms of needed treatment facilities and personnel.
Committee on Prosthetics Research and Development, Washington, D. C.