title: Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  The measurement of forced vital capacity is indispensable to predict the need for tracheostomy in patients with CSCI at the acute stage.
authors.affiliation: Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka city, Fukuoka, Japan. iyugue@orange.ocn.ne.jp
authors.forename: Itaru
authors.initials: I
authors.lastname: Yugué
authors.forename: Seiji
authors.initials: S
authors.lastname: Okada
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ueta
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maeda
authors.forename: Eiji
authors.initials: E
authors.lastname: Mori
authors.forename: Osamu
authors.initials: O
authors.lastname: Kawano
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Takao
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sakai
authors.forename: Muneaki
authors.initials: M
authors.lastname: Masuda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Morishita
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Shiba
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000601:surgery*; D014139:Tracheostomy; D014797:Vital Capacity