Medical and Functional Sequelae of Spinal Cord Injury Caused by Violence: Findings from the Model Systems

In the past two decades, there has been a significant shift in the etiology of spinal cord injury (SCI) in the United States, with a marked increase in the percentage of persons injured as a result of violence. This study used data from the National Institute on Disability and Rehabilitation Research-funded SCI model systems to compare medical and functional sequelae between SCI patients with violence-related injury (VRI) and those with non-violence-related injury (NVRI). Data for persons injured during the years 1990 through 1996 and for whom first- and second-year follow-up information was available were included. VRI patients were younger, more often white-Hispanic or African American, and male, with a limited education and unemployed at injury; 92% were injured as a result of gunshot wounds. VRI patients more often had complete injury and paraplegia and a higher mean Functional Independence Measure motor score at rehabilitation discharge. During rehabilitation and the first two follow-up years, deep vein thrombosis and autonomic dysreflexia were common in the NVRI group, whereas the incidence of serious pressure ulcers was higher in the VRI group. VRI patients had shorter rehabilitation stays but tended to have longer stays if rehospitalized. They tended to have lower Craig Handicap Assessment and Reporting Technique scores, even when scores were controlled for age and level and completeness of injury. These results suggest that there are issues regarding socioeconomic situation, access to care, and compliance that deserve further research.