Get access

Traumatic spinal cord injury in two European countries: why the differences?


Correspondence: L. Sabre, Department of Neurology and Neurosurgery, University of Tartu, 8 L. Puusepa Street, 51014 Tartu, Estonia (tel.: +37 27 318 552; fax: +37 27 318 509; e-mail:


Background and purpose

The aim of the study was to compare the incidence, causes, severity and mortality of traumatic spinal cord injury (TSCI) in Western Norway and Estonia from 1997 to 2001.


The patients were identified from hospital records. All patients were followed until death or 14 October 2011. Analysed data included demographic data, causes of injury, neurological level, American Spinal Injury Association Impairment Scale and mortality.


A total of 71 patients in Western Norway and 244 in Estonia were included. The standardized incidence rate per million was 24.9 (CI 95%, 19.4–31.7) for Western Norway and 37.4 (CI 95%, 32.8–42.5) for Estonia. Falls was the most frequent cause of TSCI in both countries. The incidence of TSCI was highest among men in their 20s in Estonia and men in their 70s in Western Norway. The median survival time among the deceased was 4.0 (95% CI, 1.50–6.50) years in Norway and 2.8 (95% CI, 1.54–4.04) in Estonia. The mean standardized mortality ratio (SMR) was 5.00 (95% CI, 4.00–6.20) in Estonia and 1.89 (95% CI, 1.23–2.77) in Western Norway.


Although the two cohorts had similar demographic, injury and clinical characteristics, the age profile of the victims was different. The incidence rate was 1.5 times higher and SMR was 2.7 times higher in Estonia. Probable explanations for the different outcomes of the two European countries are socioeconomic differences, lower physical activity level, lower life expectancy and insufficient injury prevention programmes in Estonia.