title: Factors associated with early mortality after cervical spinal cord injury.
abstract: BACKGROUND
  A relatively high early mortality rate (<30 days post-injury) for cervical spinal cord injury (SCI) has been observed.
  
  
  OBJECTIVE
  To investigate this early mortality rate observed after cervical SCI and analyze the associated influential factors.
  
  
  METHODS
  Medical records for 1163 patients with cervical SCI were reviewed, and the number of patients with early mortality was documented. Through logistic regression analysis, the effects of age, gender, occupation, cause of injury, severity of injury, highest involved spinal  cord segment, nutritional condition during hospitalization, surgical treatment, tracheotomy, etc., on early mortality were assessed. Implementation of early treatment (i.e. surgery, tracheotomy, and nutritional support) and its effect on patient prognosis were also analyzed.
  
  
  RESULTS
  Early mortality occurred in 109 of 1163 patients (9.4%). Four factors affected the early mortality rate, including level and severity of SCI, whether or not surgery was performed, the time interval between SCI and surgery, malnutrition, and tracheotomy. Patients with an American Spinal  Injury Association grade of A, a high cervical SCI (C1-C3), and/or no surgical intervention were statistically more likely to have early mortality (P < 0.001).
  
  
  CONCLUSIONS
  Severe cervical SCI, upper-level cervical cord injury, malnutrition, and  inappropriate tracheotomy are risk factors for early mortality in patients with cervical SCI. Surgery can reduce early mortality. Early tracheotomy should be performed in patients with complete upper-level cervical SCI, but patients with incomplete cervical SCI or complete low-level cervical  SCI should initially be treated surgically to maintain smooth airway flow.
authors.affiliation: Shanghai Changzheng Hospital, Shanghai, People's Republic of China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Shao
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Xiongsheng
authors.initials: X
authors.lastname: Chen
authors.forename: Lianshun
authors.initials: L
authors.lastname: Jia
authors.forename: Dianwen
authors.initials: D
authors.lastname: Song
authors.forename: Xuhui
authors.initials: X
authors.lastname: Zhou
authors.forename: Wangjun
authors.initials: W
authors.lastname: Yan
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000145:classification / Q000453:epidemiology / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult