Traumatic Spine Injury: which discrepancy between the Research Output and the actual Burden of the Disease?

ABSTRACT Objective Traumatic Spinal Injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries (LMICs). Study aim is to compare the epidemiological estimates of TSI to the corresponding amount of published papers for different regions. Methods A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical WHO Regions. A “publication to volume ratio” was obtained by comparing the average number of documents per year with the number of TSI cases across each Region. Results 2304 articles were detected from 2008-2018. The major publishing Regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71,3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). United States are the most publishing in AMR-US/Can (86.0%), Germany for EUR (22.4%). In 2018 EUR published 36.6% of paper versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. The highest publication ratios were found for AMR-US/Can and EUR, with 4.63 and 2.68 respectively. The other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03) and AFR (0.01). Conclusions A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrates the need for increased inclusiveness in guidelines generation from HICs including collection and analysis from LMICs.