title: Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury.
abstract: BACKGROUND
  Respiratory complications can undermine outcome from low cervical spinal cord injury (SCI) (C5-T1). Most devastating of these is catastrophic loss of airway control. This study sought to determine the incidence and effect of catastrophic airway loss (CLA) and to define the need for elective intubation with subsequent tracheostomy to prevent potentially fatal outcomes.
  
  
  METHODS
  A database of 54,838 consecutive patients treated in a level I trauma center between January 1988 and December 2004 was queried to identify patients with low cervical SCI, without traumatic brain injury. Patients were then stratified into complete or incomplete SCI groups, based on clinical assessment of their SCI. Mortality, age, injury severity, need for intubation, and tracheostomy were analyzed for each group using Fisher's exact test or Student's t test, as appropriate, accepting p < 0.05 as significant.
  
  
  RESULTS
  One hundred eighty-six patients met inclusion criteria. The majority of low cervical spinal cord injuries were complete (58%). Overall, 127 (68%) patients required intubation, 88 (69%) required tracheostomy, and 27 died (15% of study population). Between each group there were significant differences in age and Injury Severity Score, however, within each group there were no significant differences in either. Eleven CSCI patients were not intubated; four of whom were at family request. Six of the remaining seven patients encountered fatal catastrophic airway loss. One patient was discharged to rehabilitation. Patients with incomplete SCI required intubation less frequently (38%); however, 50% of those required tracheostomy for intractable pulmonary failure.
  
  
  CONCLUSIONS
  These data indicate that regardless of severity of low cervical SCI, immediate, thorough evaluation for respiratory failure is necessary. Early intubation is mandatory for CSCI patients. For incomplete patients evidence of respiratory failure should prompt immediate airway intervention, half of whom will require tracheostomy.
authors.affiliation: Department of Surgery, University of Florida Health Science Center, Jacksonville, Florida 32209, USA.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Hassid
authors.forename: Miren A
authors.initials: MA
authors.lastname: Schinco
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Griffen
authors.forename: Terri L
authors.initials: TL
authors.lastname: Murphy
authors.forename: Eric R
authors.initials: ER
authors.lastname: Frykberg
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
mesh_terms: D000293:Adolescent; D000328:Adult; D001049:Apnea / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002574:Cervical Vertebrae / Q000293:injuries*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016103:Spinal Fractures / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D014139:Tracheostomy