create an abstract from the findings " METHODS Study design This quantitative study used a retrospective, medical record review study approach. Convenience sampling was used to select medical records appropriately fitting the inclusion criteria. Study setting and population This study was conducted at five specialised rehabilitation units for PWSCI in the public healthcare sector of Gauteng Province. All medical records for adult individuals (≥18 years) who had sustained a confirmed SCI, irrespective of cause of injury, were considered for this study. The medical records were deemed eligible if the individual had been admitted to any of the five specialised SCI units in the public healthcare sector in Gauteng between the 1st of January 2018 and the 31st of December 2019. Those with no neurological fallout following SCI (classified as “E” according to the American Spinal Injury Association Impairment Scale) and those with neurological fallout as a result of cranial and/or peripheral nerve system pathology were excluded from the study. No sample size was calculated for this study as all medical records that met the inclusion criteria were included in the study. Data collection A pilot study of ten medical records was conducted to ensure practicality, familiarity, efficiency and quality of the data collection form and overall study procedure [28]. No amendments needed to be made to the data collection form or to the study in its entirety. Data was collected using a specifically designed data collection form which included all aspects of the International Spinal Cord Injury Core Data Set (ISCICDS) [29, 30] as well as the following data: HIV status, presence and type of comorbidities, occupation, marital status, the highest level of education, the place from where the participant was admitted into rehabilitation, rehabilitation mortality as well as the type of mobility aid used at discharge from rehabilitation. Rehabilitation ward records were used to identify patients admitted into the rehabilitation ward/s across the study period with these records being pursued and those fitting the inclusion criteria enroled in the study. Data analysis Data were summarised using descriptive statistics with inferential statistics used to investigate relationships between independent and dependent variables. The SPSS v27 was used to analyse the data and continuous variables were analysed using mean with standard deviation as well as median and interquartile ranges. Categorical variables were analysed using frequencies and percentages. Only data that was available and collectable in the medical records were included in the analysis. Our data were not normally distributed, as confirmed by a less than 0.05 significance of the Shapiro-Wilk test of normality. Hence, non-parametric tests were used to analyse the data. The Mann–Whitney U test was used to determine whether significant differences existed between continuous variables of age, days to admission, length of, stay and cause of injury. The Chi-square measure of association and the Fischer’s exact test were used to determine the associations between independent and dependent categorical variables. The Spearman correlation coefficient was used to determine the relationship between age, days to admission and length of stay. Univariate and multivariate binary logistic regression was used to determine the predictors of cause of injury. Significance was set at p < 0.05 with a 95% confidence interval. Ethical approval Ethical clearance was granted by the University of the Witwatersrand’s Human Research Ethics Committee (certificate number M200582). Additionally, permission was granted by the management of each rehabilitation unit. The medical records and data collection sheet remain anonymous and this paper does not disclose any personal information. RESULTS During the two-year study period, 998 patients were admitted for rehabilitation to Gauteng’s five specialised rehabilitation units. Of these, 386 had sustained a SCI and met all the inclusion criteria and were thus included in the study. Sociodemographic profile The mean (SD) age of study participants was 36.90 (12.12) years while the median age was 34 years (range 18–75). The most common age group was 31–45 (n = 148, 38.85%), closely followed by those 18–30 (n = 147, 38.58%) and then those 46–60 (n = 66, 17.32%) and 61 and over (n = 20, 5.25%). Participants with TSCI were significantly younger than those with NTSCI (p < 0.001). Males were more commonly injured than females (n = 270, 69.95%) across the two-year study period. Of note, females were more commonly affected by NTSCI than their male counterparts, with a male to female ratio of 5.44:1 and 0.75:1 for TSCI and NTSCI respectively. A positive and significant association was shown to exist between males and TSCI as well as between females and NTSCI (p < 0.001). Most of the participants in this study were Black (n = 357, 92.49%) and resided in the City of Tshwane (n = 91, 24.53%). A significant association was found to exist between formal employment and TSCI, with approximately half of the participants formally employed at the time of admission (n = 161, 48.20%) (p < 0.001). Unemployment and NTSCI were also found to be significantly associated (p < 0.001). A third of study participants had a matric certificate (n = 89, 35.60%). Most of the participants were never married (n = 226, 65.89%), with a significant association between TSCI and never being married, as well as between NTSCI and being married (p < 0.001). The sociodemographic profile of the included participants is presented in Table 1. Injury profile The overall prevalence of SCI in Gauteng public healthcare rehabilitation units was 38.67%. Traumatic SCI (n = 251, 65.03%) was more common than NTSCI (n = 135, 34.97%). The most common cause of injury overall was as a result of assault (n = 136, 35.23%) followed by transportation injuries (n = 87, 22.54%) and infectious causes (n = 66, 17.10%) – most commonly HIV- and tuberculosis-related. The injury frequency for TSCI and NTSCI is outlined below in Figs. 1 and 2 respectively. Of note, 5.18% of all participants (n = 20) were diagnosed with cancer and were included in the “other NTSCI” group. Most of the participants had complete lesions and were classified as AIS A as per the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) (n = 170, 56.86%). Traumatic SCI was found to be significantly associated with an AIS A injury (p < 0.001), while NTSCI and motor incomplete lesions (AIS C and AIS D) were significantly associated (p < 0.001). The most common site of injury was the lower thoracic region of T7-T12 (n = 105, 39.92%) (Table 2). Most participants in this study were admitted into rehabilitation from tertiary-level healthcare institutions (n = 223, 62.82%). There was a mean (SD) time of 64.48 (59.78) days between the day of injury and day to rehabilitation admission (median 46 days, range 1–369), with the NTSCI group having a significantly longer waiting period than their TSCI counterparts (p < 0.001). Once admitted, the mean (SD) length of stay in rehabilitation was 85.59 (63.21) days (median 72 days, range 5–388 days). Most of the study participants were classified as HIV negative (n = 151, 69.91%) and most did not present with any health comorbidity (n = 243, 73.19%). Significant associations were found to exist between the NTSCI group and being HIV positive (p < 0.001) as well as having a health comorbidity (p < 0.001). The most common comorbidity was tuberculosis (n = 44, 11.40%) followed by hypertension (n = 26, 6.74%) and diabetes (n = 5, 1.30%). Vertebral fractures were common (n = 256, 77.11%), with the high proportion in the NTSCI group likely a reflection of the disease process associated with spinal tuberculosis. Just under one half of the participants received spinal surgery (n = 154, 44.51%). There was a significant association between the TSCI group and both of these data sets M.A. Alves et al. 2 Spinal Cord Series and Cases (2023) 9:15 (p < 0.001). Associated injuries (as defined by the ISCICDS and only recorded in persons with TSCI) were found to exist in just under half of the participants in the TSCI group (n = 85, 43.82%). The injury profile of the included participants is presented in Table 3. Overall, most of the participants in this study were discharged from rehabilitation (n = 342, 88.60%) with an overwhelming proportion being discharged to a private residence (n = 330, 97.29%). Successful discharge from rehabilitation was significantly associated with the TSCI group with those sustaining a NTSCI more likely to not be discharged (p < 0.001). Of those that were not discharged from rehabilitation, 25 participants demised (6.48%), eight refused further rehabilitation care (2.07%), seven absconded (1.81%), and four became medically unstable and were deemed unfit to continue rehabilitation and were transferred back to acute care (1.04%). No participants made use of a ventilator or supplementary oxygen at discharge. Manually-operated wheelchairs (n = 185, 57.81%) were the most common type of assistive device used for mobility at discharge from rehabilitation. The injury profile information related to rehabilitation completion is provided in Table 4. Binary logistic regression was used to explore sociodemographic predictors of SCI (Table 5). The probability of acquiring a TSCI was found to increase by 0.94 for every one-unit increase in Table 1. Sociodemographic Profile. Overall (n = 386) TSCI (n = 251) NTSCI (n = 131) p-value Age 0.00a Mean (SD) 36.90 (12.12) Median 34 31 44 Range 18–75 Q1–Q3 26–39.75 32.5–51.5 Gender, n (%) 386 251 135 0.00a Male 270 (69.95) 212 (84.46) 58 (42.96) Female 116 (30.05) 39 (15.54) 77 (57.04) Ethnicity, n (%) 386 251 135 0.08b Black 357 (92.49) 236 (94.02) 121 (89.63) White 13 (3.37) 5 (2.00) 8 (5.93) Coloured 14 (3.63) 10 (3.98) 4 (2.96) Indian 2 (0.52) 0 2 (1.48) Area of residence, n (%) 371 245 126 0.06b City of Tshwane 91 (24.53) 51 (20.82) 40 (31.75) City of Johannesburg 88 (23.72) 62 (25.31) 26 (20.63) City of Ekurhuleni 76 (20.49) 58 (23.67) 18 (14.29) West Rand 15 (4.04) 7 (2.86) 6 (4.76) Sedibeng 13 (3.50) 12 (4.90) 3 (2.38) Another Province 88 (23.72) 55 (22.45) 33 (26.19) Occupation, n (%) 334 229 105 0.00a Unemployed 90 (26.95) 49 (21.39) 41 (39.05) Self-employed 53 (15.87) 39 (17.03) 14 (13.33) Formally employed 161 (48.20) 124 (54.15) 37 (35.24) Student 17 (5.09) 14 (6.11) 3 (2.86) Pensioner 13 (3.89) 3 (1.31) 10 (9.52) Marital Status, n (%) 343 226 117 0.00a Never Married 226 (65.89) 171 (75.66) 55 (47.01) Married 93 (27.11) 45 (19.91) 48 (41.03) Divorced 11 (3.21) 6 (2.65) 5 (4.27) Widowed 13 (3.79) 4 (1.77) 9 (7.69) Education, n (%) 250 177 73 0.22 Grade 9 or lower 59 (23.60) 47 (26.55) 12 (16.67) Grade 10–11 84 (33.60) 61 (34.46) 23 (31.94) Grade 12 89 (35.60) 59 (33.33) 30 (41.67) Post-secondary 18 (7.20) 10 (5.65) 8 (11.11) Young, Black males are the most prevalent population group admitted for rehabilitation after TSCI. In the NTSCI population group, older women were significantly more common. A relatively similar proportion of participants resided in the City of Tshwane, City of Johannesburg as well as in The City of Ekurhuleni at the time of their injury. Most participants were formally employed and had never married at their time of injury with significant associations existing between these sociodemographic factors and injury aetiology. No association was found between participants’ highest level of education and injury aetiology. a Significant p value. b Fischer’s exact test. M.A. Alves et al. 3 Spinal Cord Series and Cases (2023) 9:15 Fig. 2 Aetiology of non-traumatic spinal cord injury. Infection-related causes were the most common followed by other NTSCI causes (most commonly cancer) and degenerative conditions. Table 2. Injury severity and classification. Overall TSCI NTSCI p-value Injury classification, n (%) 299 232 67 0.00a AIS A 170 (56.86) 143 (61.64) 27 (40.30) AIS B 15 (5.02) 12 (5.17) 3 (4.48) AIS C 65 (21.74) 38 (16.38) 27 (40.30) AIS D 16 (5.35) 10 (4.31) 6 (8.96) Incomplete syndrome 33 (11.04) 29 (12.50) 4 (5.97) Level of injury, n (%) 263 197 66 0.88 C1–C4 22 (8.37) 15 (7.6) 7 (10.3) C5–C8 33 (12.55) 26 (13.2) 7 (10.3) T1–T6 70 (26.62) 51 (25.9) 19 (27.9) T7–T12 105 (39.92) 80 (40.6) 25 (36.8) L1–L5 35 (13.31) 25 (12.7) 10 (14.7) The majority of the participants sustained a complete, AIS A injury as per the International Standards for Neurological Classification of SCI (ISNCSCI). Participants with NTSCI were significantly more likely to sustain an incomplete injury compared to their TSCI counterparts. The lower thoracic spine (T7–T12) was the area most commonly injured, followed by the upper thoracic spine (T1–T6). a Significant p value. Fig. 1 Aetiology of traumatic spinal cord injury. Traumatic SCI accounted for almost two-thirds of injury with injuries mostly resulting from gunshots and motor vehicle accidents. M.A. Alves et al. 4 Spinal Cord Series and Cases (2023) 9:15 age (p < 0.001) and by 0.14 in females as compared with their male counterparts (p < 0.001). Being unemployed was found to increase the odds of acquiring a TSCI by 0.37 (p < 0.001). Traumatic SCI was found to be a significant predictor for sustaining a vertebral fracture as well as for requiring spinal surgery (p < 0.001) as illustrated in Table 6. Binary logistic regression was also used to explore sociodemographic factors in relation to injury outcomes (Table 7). The probability of sustaining a vertebral fracture was found to increase significantly by 0.37 in females and 0.26 in the unemployed respectively (p < 0.001). A significant correlation exists between rehabilitation mortality and age with the risk of death increasing by 0.92 for every one-unit increase in age (p < 0.001).”