Spinal Cord Injury in the 21st Century Part II: Deficiencies in Data

In Part I of this series we identified spinal cord injury without fracture or dislocation (SCIwoFD) as having become the most common type of spinal cord injury at our level I trauma center. The purpose of this paper was to examine two databases, one local and one national, to determine whether this population could be discovered using traditional search techniques.

We analyzed ICD-10 codes applied by our institution to SCIwoFD patients identified in Part I for accuracy and appropriateness. Concurrently, we queried the National Inpatient Sample (NIS) database between 2015 and 2019 to identify an anticipated increase in SCIwoFD patients compared to patients with more traditional spinal cord injury (SCI) associated with fracture/dislocation.

The most common ICD-10 diagnosis provided for SCIwoFD patients at our institution was coded as cervicalgia (33%) followed by cervical spinal stenosis (21%). Five percent were coded for myelopathy, while central cord syndrome was coded in only 2%. Within the NIS, SCIwoFD was reported in only 15% of patients in sharp contrast to 82% of our own patients (P < 0.00001). Conversely, SCI associated with fracture/dislocation comprised 85% of all reported NIS cSCIs holding steady at this level during the study period, as did central cord syndrome (7%) and traumatic spondylopathy (1%).

Neither our institutional database nor the NIS allows for appropriate identification of patients suffering SCIwoFD. Properly constructed SCI-specific registries are likely to provide the only opportunity from which to establish best practice parameters for this new 21st-century demographic of SCI.