result in paraplegia (loss of movement and sensation in the lower body) or the loss of specific functions.

An injury is categorized as complete if the patient has no sensory or motor function below the level of injury and as incomplete if the patient has such function (see Chapter 2). Data from the Model Spinal Cord Injury System since 2000 show that the most frequent neurological category at discharge is incomplete quadriplegia (34.3 percent), followed by complete paraplegia (25.1 percent), complete quadriplegia (22.1 percent), and incomplete paraplegia (17.5 percent) (NSCISC, 2004). Depending on the extent of the injury, the individual can recover some function and sensation (Levi, 2004). Many patients with complete paraplegia at 72 hours postinjury do not regain any function (Maynard et al., 1979). Individuals with incomplete paraplegia or tetraplegia have higher rates of improvements in motor function (Ditunno et al., 2000). An important prognostic factor is the preservation of sensation, particularly in the anal area. In one study, 47 percent of patients with incomplete sensory function at 72 hours postinjury and 87 percent of patients with incomplete motor function at 72 hours postinjury recovered the ability to walk within a year (Maynard et al., 1979).

The economic costs of spinal cord injuries largely depend on the severity of the injury and the nature of the resulting disability. The costs are highest in the first year after injury, primarily because of emergency, hospital, and rehabilitation care costs. Data on hospital admissions show that the average length of hospital stay in the acute care unit for patients with spinal cord injuries declined from 25 days in 1974 to 15 days in 2002; over that same period similar decreases were seen for stays in rehabilitation facilities (a decrease from 115 days to 40 days) (NSCISC, 2004). An analysis of the potential impacts of these reductions was not provided.

In 1996, the total annual cost of spinal cord injuries in the United States was estimated to be $9.73 billion, including an estimated $2.6 billion in lost productivity (Table 1-3) (Berkowitz et al., 1998). Of the total cost, first year costs were estimated to be $2.58 billion. Individuals with spinal cord injuries also incur significant costs for home and vehicle modifications, equipment purchase, medications, and personal assistance services (Table 1-4), with an estimate of $244,000 for each individual’s first-year medical and home modification costs (Berkowitz et al., 1998). Costs are higher for those with more disabling injuries (Table 1-4).

In discussing the health outcomes from spinal cord injuries and their associated costs, it is helpful to put these types of injuries into perspective with other diseases and health conditions (Table 1-5). Spinal cord injuries, although relatively infrequent health outcomes, impose heavy economic costs on society, particularly as they often affect young people and severely limit their productivity and quality of life. The economic costs to an indi-



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