A systematic review on the epidemiology of war-related spinal cord injury among soldiers:
Furlan J, Gulasingam S, Craven B
Lyndhurst Centre, Toronto Rehabilitation Institute & University of Toronto, Toronto, ON, Canada
Objective: Wartime necessitates efficiency and provides opportunity to improve medical knowledge that can eventually translate into enhanced civilian management. Although many published studies have reported on the epidemiology of war-related spinal cord injuries (SCIs), there has been no prior systematic review on this topic in the literature. Given this, we systematically review and critically appraise the literature on the epidemiology of war-related SCIs.
Design/Method: Medline, EMBASE and PsycINFO databases were searched for articles on economic impact of management of SCI/D veterans, published from 1946 to September/2016. The search criteria included subject headings (“spinal cord injury” OR “spinal cord injuries”) AND (“trauma” OR “wounds and injuries”), AND (“military” OR “military personnel” OR “war” OR “veterans” OR “combatants” OR “soldiers”), limited to “humans”. Abstracts and, when necessary, actual articles were screened to identify papers that studied the incidence and epidemiology of war-related SCI among combatants. This systematic review included all original articles that reported on: incidence, demographics, or injury characteristics of the war-related SCIs; bodily injuries associated with SCI; or frequency of SCI among other bodily injuries. Case reports, animal studies, conference abstracts only, and editorials were excluded. The STROBE statement was used to determine publication quality.
Results: The literature search identified 1,573 publications, of which 24 articles fulfilled the inclusion and exclusion criteria. The studies were classified into the following topics: 17 articles reported demographics, level and severity of SCI, mechanism of injury and/or associated bodily injuries; 5 articles reported the incidence of war-related SCI; and 6 articles reported the frequency of SCI among other war-related bodily injuries. Overall, military personnel with war-related SCI were typically young, white men, with predominantly thoracic or lumbar level, severe degree of SCI (complete or AIS A), secondary to gunshot or explosion and often associated with other bodily injuries. Marines appear to be at a greater risk of war-related SCI than the military personal in the Army, Navy and Air Force.
Conclusion: The results of this review suggest that soldiers with war-related SCIs are distinct from traumatic SCIs seen among the general population. Although the clinical implications of war-related SCIs were not completely understood, their features are potentially associated with poorer prognosis that offset the few positive prognostic factors.
Support: The first author receives salary support from the Wings for Life Spinal Cord Research Foundation.
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