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Published on: May 28, 2014
A Study of Risk Factors for Tracheostomy in Patients With a Cervical Spinal Cord Injury
Jun Tanaka1, Itaru Yugue, Keiichiro Shiba
1*Faculty of Medicine, Department of Orthopaedic Surgery, Fukuoka University†Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka city, Fukuoka, Japan.
Study Design:
A retrospective, consecutive case series.
Objective:
To determine the risk factors for a tracheostomy in patients with a cervical spinal cord injury.
Summary And Background Date:
Respiratory status cannot be stabilized in patients with a cervical spinal cord injury (CSCI) for various reasons, so a number of these patients require long-term respiratory care and a tracheostomy. Various studies have described risk factors for a tracheostomy, but none have indicated a relationship between imaging assessment and the need for a tracheostomy. The current study used imaging assessment and other approaches to assess and examine the risk factors for a tracheostomy in patients with a CSCI.
Methods:
Subjects were 199 patients who were treated at the Spinal Injuries Center within 72 hours of a CSCI over 8-year period. Risk factors for a tracheostomy were retrospectively studied. Patients were assessed in terms of 10 items: age, sex, the presence of a vertebral fracture or dislocation, ASIA Impairment Scale, the neurological level of injury (NLI), PaO2, PaCO2, the level of injury on magnetic resonance imaging (MRI), the presence of hematoma-like changes (a hypointense core surrounded by a hyperintense rim in T2-weighted images) on MRI, and the Injury Severity Score.Items were analyzed multivariate logistic regression, and P < 0.05 was considered to indicate a significant difference.
Results:
Twenty-three of the 199 patients required a tracheostomy, accounting for 11.6% of patients with a CSCI. Univariate analyses of the risk factors for tracheostomy revealed significant differences for six items: age, Injury Severity Score, presence of fracture or dislocation, ASIA Impairment Scale A, NLI C4 or above, and MRI scans revealing hematoma-like changes. Multivariate logistic regression analyses revealed significant differences in terms of two items: NLI C4 or above and MRI scans revealing hematoma-like changes. Thirty patients had both an NLI C4 or above and MRI scans revealing hematoma-like changes. Of these, 17 (56.7%) required a tracheostomy.
Conclusion:
Patients with an NLI C4 or above and MRI scans revealing hematoma-like changes were likely to require a tracheostomy. An early tracheostomy should be considered for patients with both of these characteristics.
Level Of Evidence:
3.
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