Spinal cord injury in the context of major motor vehicle collision trauma: a retrospective ecological analysis of global estimates across income groups

Nutbeam, Tim; Caterson, Jessica; Saunders, Colleen J.; Sawe, Hendry R.; Jamaluddin, Sabariah Faizah; Roberts, Ian; Smith, Jason E.; Ambunda, Paulus; Stassen, Willem · 2025 · Crossref

DOI: 10.1186/s13049-025-01536-7

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Summary

This study addresses the global burden of spinal cord injuries (SCIs) resulting from motor vehicle collisions (MVCs), a critical gap in understanding post-crash care priorities. While road traffic injuries are a leading cause of death and disability, particularly in low- and middle-income countries (LMICs), the specific incidence of SCIs relative to other injuries remains poorly characterized globally. The research was motivated by the need to determine whether the low incidence of SCIs observed in UK trauma registries is consistent across different income groups and regions, thereby informing global post-crash protocols that often prioritize spinal immobilization. The authors conducted a retrospective ecological analysis using data from the Global Burden of Disease (GBD) 2019 study, covering 204 countries and territories between 2012 and 2019. The study examined MVC-related mortality, major non-fatal injuries, and SCIs, stratified by World Bank income groups (low, lower-middle, upper-middle, and high) and sex. Statistical methods included linear regression, Quasi-Poisson regression to account for overdispersion, and non-parametric tests to compare incidence rate ratios and the proportion of SCIs among all non-fatal injuries. The analysis focused on "motor vehicle road injuries," excluding pedestrians, cyclists, and motorcyclists. The results indicate that MVC-related mortality incidence rates were significantly lower in high-income countries (HICs), upper-middle-income countries (UMICs), and lower-middle-income countries (LMICs) compared to low-income countries (LICs). Globally, SCIs accounted for approximately 0.5% of all major non-fatal MVC-related injuries, with lower extremity and head injuries being far more prevalent. While the absolute incidence of SCIs did not differ significantly between income groups, the proportion of SCIs among survivors was significantly higher in LICs (median 0.833%) compared to other income groups. Males consistently exhibited higher incidence rates for mortality, non-fatal injuries, and SCIs across all income levels. Additionally, median injury incidence rates increased annually in LMICs but decreased in UMICs and HICs. The study concludes that while SCIs from MVCs are relatively rare globally, they disproportionately affect LICs in terms of proportional burden. The findings challenge current post-crash practices that heavily emphasize spinal protection and prolonged immobilization, suggesting such measures may delay time-critical care for more common, life-threatening injuries like head and thoracic trauma. The authors recommend strengthening bystander response, developing context-specific post-crash protocols, and improving prehospital systems, particularly in resource-limited settings, to reduce disparities and improve outcomes.

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Topics

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• demographic disparities
• incidence prevalence
• fatality injury trends
• comparative international

Information type

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• Empirical Findings: crash risk outcomes