A new 70 year UK study into life expectancy following traumatic spinal cord injury has now been formally published in Spinal Cord the journal of the International Spinal Cord Society. The citation for the paper is shown below, and experts should now be taking this study into account when reaching views on life expectancy impairment.
The assessment of reduction in life expectancy following traumatic spinal cord injury, even where some losses dealt with on a periodical payment basis, can have a significant impact on the size of damages. This impact is increased in the context of the revised rate’s multipliers and even more so if the new rates encourage less PPOs and more attempts for total lump sum awards.
Long term survival after traumatic spinal cord injury: A 70 year study
Reference is usually made by experts and in the reported spinal cases, to the Strauss (2000 and 2006) studies (US) , Middleton (2012) study (Australia) and Shavelle (2015) study (US again) which need conversion to UK life expectancies.
The previous UK study into life expectancy following traumatic spinal cord injury was last carried out in 1990s and usually referred to as 'Frankel 1998'. That was a 50 year study – the new study updates it to increase the span of data to 70 years.
Some limited details of the study outcomes were published in late 2016 (see below). The absence of formal publication meant some experts were reluctant to consider the results when reaching a view on life expectancy (though some were prepared to).
The study covers patients (5,000+) at Stoke Mandeville and Southport spinal injury centres between 1943 and 2010 excluding those dying within the first year of injury. Data was collated by age, gender and five injury severity types: D Grade, Paraplegia ABC, Tetraplegia C5-8 ABC, Tetraplegia C1-4 ABC and Ventilated (see appended description of ASIA Grades). The life expectancies are displayed as a percentage of general population life expectancy (note that this is observed life expectancy, not projected).
The study results
Towards the end of 2016 limited information was produced in the form of a 'poster report'. It is still accessible on the National Spinal Injuries Centre section of the Buckinghamshire Healthcare NHS Trust website.
Whilst the information on the poster report matches that in the published paper, the latter covers the study findings more extensively. For example the poster report shows life expectancies by injury severity only for ages 20, 40 and 60 – which may be helpful for reserving – whereas the paper has 15 age levels at five year intervals from 10 to 80. This level of detail will be needed by experts when considering life expectancy opinions and they should refer to the paper. The following are just four examples each of male and female age 20, showing the percentage of general population life expectancy:
Although it is not always possible to directly compare findings between studies, due often to differences in methodology or classification, the following is indicative of how the 70 year study outcomes sit with other studies relied upon. Again a 20 year old as the comparator. However it is stressed this is purely indicative and it will be a matter for expert opinion as to where the study sits in the overall clinical decision on life expectancy impairment.
NB to the table: The detail in italics show best fit of categories from studies against the 70 year study. A percentages in bold is the life expectancy at the age quoted as a percentage of the normal life expectancy at that age and in the country of the study. Account has to be taken of the higher age in the Shavelle and Middleton studies as well as adjustments needed for higher UK projected life expectancies. When account is taken of those two factors most of the percentages in the 70 year study point, in some instances to lower impaired life expectancies, but the full paper’s data should be referred to.
As the first UK study for a number of years, the results will be more directly applicable to UK claimants and to ensure that future loss periods and accompanying multipliers are appropriately assessed, it should be included amongst the reference material considered by clinicians.
Appendix - ASIA Grades
Nicholas Thorne - 0161 838 6330
Sharon Lomas - 0161 838 6739
Lauren Gosnell - 0161 838 6308
Hayley Nicol - 0161 819 3297
Nick, Sharon, Lauren and Hayley are members of the Spinal Injuries Subject Matter Expert Group within BLM’s Catastrophic Injury Group.