Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury

Itaru Yugué, Seiji Okada, Takayoshi Ueta, Takeshi Maeda, Eiji Mori, Osamu Kawano, Tsuneaki Takao, Hiroaki Sakai, Muneaki Masuda, Tetsuo Hayashi, Yuichiro Morishita, Keiichiro Shiba

Research output: Contribution to journalArticle

21 Citations (Scopus)

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 patients with cervical spinal cord injury (CSCI) at the acute stage. SUMMARY OF BACKGROUND DATA. Respiratory complications remain a 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 patients with spinal cord injury, but there are very few studies in which the forced vital capacity was investigated as a risk factor for tracheostomy. METHODS. This study that 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's age, neurological impairment scale grade and level, smoking history, pre-existing medical comorbidities, respiratory diseases, Injury Severity Score, forced vital capacity, 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 tracheostomy (10.03%). The factors identified using a multiple logistic regression model were high age (69 years of age or older), severe neurological impairment scale, low forced vital capacity (≤500 mL), and low percentage of vital capacity to the predicted value (<16.3%). The decision tree analysis demonstrated that forced vital capacity, the severe neurological impairment scale, and high patient age were predictive of need for tracheostomy on 94.4% occasions. CONCLUSION. The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage.

Original languageEnglish
JournalSpine
Volume37
Issue number26
DOIs
Publication statusPublished - Dec 15 2012

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Tracheostomy
Spinal Cord Injuries
Vital Capacity
Logistic Models
Cervical Cord
Decision Trees
Injury Severity Score
Decision Support Techniques
Comorbidity
Multivariate Analysis
Smoking
History
Regression Analysis
Morbidity
Mortality

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Orthopedics and Sports Medicine

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Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury. / Yugué, Itaru; Okada, Seiji; Ueta, Takayoshi; Maeda, Takeshi; Mori, Eiji; Kawano, Osamu; Takao, Tsuneaki; Sakai, Hiroaki; Masuda, Muneaki; Hayashi, Tetsuo; Morishita, Yuichiro; Shiba, Keiichiro.

In: Spine, Vol. 37, No. 26, 15.12.2012.

Research output: Contribution to journalArticle

Yugué, I, Okada, S, Ueta, T, Maeda, T, Mori, E, Kawano, O, Takao, T, Sakai, H, Masuda, M, Hayashi, T, Morishita, Y & Shiba, K 2012, 'Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury', Spine, vol. 37, no. 26. https://doi.org/10.1097/BRS.0b013e31827417f1
Yugué, Itaru ; Okada, Seiji ; Ueta, Takayoshi ; Maeda, Takeshi ; Mori, Eiji ; Kawano, Osamu ; Takao, Tsuneaki ; Sakai, Hiroaki ; Masuda, Muneaki ; Hayashi, Tetsuo ; Morishita, Yuichiro ; Shiba, Keiichiro. / Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury. In: Spine. 2012 ; Vol. 37, No. 26.
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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 patients with cervical spinal cord injury (CSCI) at the acute stage. SUMMARY OF BACKGROUND DATA. Respiratory complications remain a 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 patients with spinal cord injury, but there are very few studies in which the forced vital capacity was investigated as a risk factor for tracheostomy. METHODS. This study that 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's age, neurological impairment scale grade and level, smoking history, pre-existing medical comorbidities, respiratory diseases, Injury Severity Score, forced vital capacity, 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 tracheostomy (10.03{\%}). The factors identified using a multiple logistic regression model were high age (69 years of age or older), severe neurological impairment scale, low forced vital capacity (≤500 mL), and low percentage of vital capacity to the predicted value (<16.3{\%}). The decision tree analysis demonstrated that forced vital capacity, the severe neurological impairment scale, and high patient age were predictive of need for tracheostomy on 94.4{\%} occasions. CONCLUSION. The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage.",
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AU - Yugué, Itaru

AU - Okada, Seiji

AU - Ueta, Takayoshi

AU - Maeda, Takeshi

AU - Mori, Eiji

AU - Kawano, Osamu

AU - Takao, Tsuneaki

AU - Sakai, Hiroaki

AU - Masuda, Muneaki

AU - Hayashi, Tetsuo

AU - Morishita, Yuichiro

AU - Shiba, Keiichiro

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N2 - 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 patients with cervical spinal cord injury (CSCI) at the acute stage. SUMMARY OF BACKGROUND DATA. Respiratory complications remain a 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 patients with spinal cord injury, but there are very few studies in which the forced vital capacity was investigated as a risk factor for tracheostomy. METHODS. This study that 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's age, neurological impairment scale grade and level, smoking history, pre-existing medical comorbidities, respiratory diseases, Injury Severity Score, forced vital capacity, 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 tracheostomy (10.03%). The factors identified using a multiple logistic regression model were high age (69 years of age or older), severe neurological impairment scale, low forced vital capacity (≤500 mL), and low percentage of vital capacity to the predicted value (<16.3%). The decision tree analysis demonstrated that forced vital capacity, the severe neurological impairment scale, and high patient age were predictive of need for tracheostomy on 94.4% occasions. CONCLUSION. The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage.

AB - 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 patients with cervical spinal cord injury (CSCI) at the acute stage. SUMMARY OF BACKGROUND DATA. Respiratory complications remain a 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 patients with spinal cord injury, but there are very few studies in which the forced vital capacity was investigated as a risk factor for tracheostomy. METHODS. This study that 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's age, neurological impairment scale grade and level, smoking history, pre-existing medical comorbidities, respiratory diseases, Injury Severity Score, forced vital capacity, 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 tracheostomy (10.03%). The factors identified using a multiple logistic regression model were high age (69 years of age or older), severe neurological impairment scale, low forced vital capacity (≤500 mL), and low percentage of vital capacity to the predicted value (<16.3%). The decision tree analysis demonstrated that forced vital capacity, the severe neurological impairment scale, and high patient age were predictive of need for tracheostomy on 94.4% occasions. CONCLUSION. The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage.

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