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Analysis of the Risk Factors for Tracheostomy in Traumatic Cervical Spinal Cord Injury.
MedLine Citation:
PMID:  22996266     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
STRUCTURED ABSTRACT: Study Design. A retrospective, consecutive case series.Objective. To determine the risk factors that have a statistically significant association with the need of tracheostomy in the patients with cervical spinal cord injury (CSCI) at the acute stage.Summary of Background Data. Respiratory complications remain major cause of further morbidity and mortality in patients with CSCI. Although several risk factors for tracheostomy have been postulated in these patients, no definitive factors have yet been established according to a multivariate analysis. The use of vital capacity was considered as a single global measure of respiratory function in spinal cord injury patients but there are very few studies in which the forced vital capacity was investigated as a risk factor for tracheostomy.Methods. This study reviewed the clinical data of 319 patients with CSCI, who were evaluated for their neurological impairment within 2 days after injury, was performed. We analyzed the factors postulated to increase the risk for tracheostomy, including patient age, neurological impairment scale grade and level, smoking history, preexisting medical comorbidites, respiratory diseases, Injury severity score (ISS), force vital capacity (FVC), and percentage of vital capacity to the predicted value (%VC) using a multiple logistic regression model and classification and regression tree analysis.Results. Of 319 patients, 32 patients received a tracheostomy (10.03%). The factors identified using a multiple logistic regression model were high age (≥69 years old), severe neurological impairment scale, low forced vital capacity (≤500ml) and low percentage of vital capacity to the predicted value (<16.3%). The decision tree analysis demonstrated that FVC, the severe neurological impairment scale, and high patient age were predictive of need for tracheostomy on 94.4% occasions.Conclusions. The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in cervical spinal cord injury patients at the acute stage.
Authors:
Itaru Yugué; Seiji Okada; Takayoshi Ueta; Takeshi Maeda; Eiji Mori; Osamu Kawano; Tsuneaki Takao; Hiroaki Sakai; Muneaki Masuda; Tetsuo Hayashi; Yuichiro Morishita; Keiichiro Shiba
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-19
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka city, Fukuoka Japan; and the †Department of Orthopaedic Surgery, Kyushu university, Fukuoka, Japan.
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