Document Detail


Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A.
MedLine Citation:
PMID:  14748569     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The authors sought to identify variables that predispose patients with acute American Spinal Injury Association (ASIA) Grade A cervical spinal cord injury (SCI) to require tracheostomies for ventilator support or airway protection. METHODS: A retrospective analysis was performed of 178 consecutive patients with a cervical ASIA Grade A SCI who were admitted through the Delaware Valley SCI Center at Thomas Jefferson Hospital during a 6-year period. Exclusion criteria included injury occurring more than 48 hours prior to admission, death within 14 days of admission or nontraumatic SCI. Twenty-two patients were excluded based on these criteria. Parameters evaluated in the remaining population (156 patients) included demographics, cervical vertebral ASIA level, tracheostomy placement, pneumonia, premorbid pulmonary disease, smoking history, evidence of direct thoracic/lung trauma, operative intervention, associated appendicular trauma, and preexisting medical comorbidities. The ASIA classification of the 156 patients included in this analysis were C-2 (eight), C-3 (11), C-4 (64), C-5 (36), C-6 (20), C-7 (13), and C-8 (four). Tracheostomies were performed in 107 of these 156 patients. Statistical analysis revealed a significant relationship between tracheostomy and patient age (p = 0.0048), preexisting medical conditions (p = 0.0417), premorbid lung disease (p = 0.0177), higher cervical ASIA level (p < 0.0001), and the presence of pneumonia (p < 0.0001). No patient with a C-8 ASIA A injury required tracheostomy, whereas all C-2 and C-3 ASIA A-injured patients underwent tracheostomies. Patients older than 45 years of age with ASIA A levels between C-4 and C-7 more commonly required tracheostomy (p < 0.005) than patients younger than 45 years of age. CONCLUSIONS: Several risk factors were identified that corresponded to the frequent tracheostomy placement in the acute injury phase after complete cervical SCI. Early tracheostomy may be considered in patients with multiple risk factors to reduce duration of stay in the intensive care unit and facilitate ventilatory weaning.
Authors:
James S Harrop; Ashwini D Sharan; Edward H Scheid; Alexander R Vaccaro; Gregory J Przybylski
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  100     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-29     Completed Date:  2004-02-17     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  20-3     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. James.Harrop@jefferson.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cervical Vertebrae / injuries
Decompression, Surgical
Female
Health Services Needs and Demand / statistics & numerical data
Humans
Lung Diseases / complications
Male
Middle Aged
Postoperative Complications / rehabilitation
Respiratory Distress Syndrome, Adult / complications
Retrospective Studies
Risk Factors
Spinal Cord Injuries / rehabilitation*
Tracheostomy* / statistics & numerical data
Ventilator Weaning
Grant Support
ID/Acronym/Agency:
H133N00027//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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