FIREARM VERSUS MOTOR-VEHICLE RELATED SPINAL-CORD INJURY - PREINJURY FACTORS, INJURY CHARACTERISTICS, AND INITIAL OUTCOME COMPARISONS AMONG ETHNICALLY DIVERSE GROUPS

Objective: To determine the extent to which individuals with spinal co rd injuries caused by firearms differed from those caused by motor veh icle crash (MVC) in terms of selected preinjury factors, injury charac teristics and related treatment, and outcomes at discharge from rehabi litation; and to determine the effect of ethnicity on preinjury factor s and outcome. Design: Survey including interview of former rehabilita tion inpatients and medical records review. Setting: Model Spinal Cord Injury Care System centered at an urban, public rehabilitation medica l center. Participants: Volunteer convenience sample of 164 men who we re between the ages of 18 and 35 years at the time of injury and who w ere injured by firearm or MVC between January 1, 1980 and December 31, 1989. Subjects had completed rehabilitation at a rehabilitation cente r; they were non-Latino White, African-American, or Latino. Subjects w ere contacted by mail and telephone. The sample was comprised of 264b of the potential participants; however, differential follow-up rates w ere highly consistent with distribution of primary characteristics wit hin the population of potential candidates. Main Outcome Measures: The Functional Independence Measure (FIM) and total and rehabilitation le ngths of stay were the outcome measures. Groups and outcomes were also compared in terms of preinjury education, employment, and indicators of antisocial behavior, as well as neurological deficit, associated in juries, and surgical treatment. Results: The firearm and MVC groups we re different in terms of ethnic distribution. There were no non-Latino Whites in the firearm group and few African-Americans in the MVC grou p. With the exception of preinjury education, nonparametric and univar iate tests showed differences between the firearm and MVC groups in te rms of preinjury employment and indicators of antisocial behavior, ass ociated injuries, surgical treatment, neurological deficit, and length s of stay. Changes in FIM scores, however, were not different between etiologic or ethnic groups. Multiple regression indicated that injury severity accounted for the largest variance in outcomes and that prein jury factors, etiology, and ethnicity did not contribute significantly to the variance in outcome measures. Conclusions: Although preinjury factors are associated with ethnicity and minorities have higher propo rtions of SCI caused by firearms, these factors do not significantly i nfluence rehabilitation outcomes at discharge. The primary factors inf luencing rehabilitation outcomes are related to the deficits, associat ed physical injuries, and related treatments common to the causes of t he injury. (C) 1997 by the American Congress of Rehabilitation Medicin e and the American Academy of Physical Medicine and Rehabilitation.