title: A Study of Risk Factors for Tracheostomy in Patients With a Cervical Spinal Cord Injury.
abstract: METHODS
  A retrospective, consecutive case series.
  
  
  OBJECTIVE
  To determine the risk factors for a tracheostomy in patients with a cervical spinal cord injury.
  Respiratory status cannot be stabilized in patients with a cervical spinal cord injury (CSCI) for various reasons, so a number of these patients require long-term respiratory care and a tracheostomy. Various studies have described risk factors for a tracheostomy, but none have indicated a relationship between imaging assessment and the need for a tracheostomy. The current study used imaging assessment and other approaches to assess and examine the risk factors for a tracheostomy in patients with a CSCI.
  
  
  METHODS
  Subjects were 199 patients who were treated at the Spinal Injuries Center within 72 hours of a CSCI over 8-year period. Risk factors for a tracheostomy were retrospectively studied. Patients were assessed in terms of 10 items: age, sex, the presence of a vertebral fracture or dislocation, ASIA Impairment Scale, the neurological level of injury (NLI), PaO2, PaCO2, the level of injury on magnetic resonance imaging (MRI), the presence of hematoma-like changes (a hypointense core surrounded by a hyperintense rim in T2-weighted images) on MRI, and the Injury Severity Score.Items were analyzed multivariate logistic regression, and P < 0.05 was considered to indicate a significant difference.
  
  
  RESULTS
  Twenty-three of the 199 patients required a tracheostomy, accounting for 11.6% of patients with a CSCI. Univariate analyses of the risk factors for tracheostomy revealed significant differences for six items: age, Injury Severity Score, presence of fracture or dislocation, ASIA Impairment Scale A, NLI C4 or above, and MRI scans revealing hematoma-like changes. Multivariate logistic regression analyses revealed significant differences in terms of two items: NLI C4 or above and MRI scans revealing hematoma-like changes. Thirty patients had both an NLI C4 or above and MRI scans revealing hematoma-like changes. Of these, 17 (56.7%) required a tracheostomy.
  
  
  CONCLUSIONS
  Patients with an NLI C4 or above and MRI scans revealing hematoma-like changes were likely to require a tracheostomy. An early tracheostomy should be considered for patients with both of these characteristics.
  
  
  METHODS
  3.
authors.affiliation: *Faculty of Medicine, Department of Orthopaedic Surgery, Fukuoka University†Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka city, Fukuoka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tanaka
authors.forename: Itaru
authors.initials: I
authors.lastname: Yugue
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Shiba
authors.forename: Akira
authors.initials: A
authors.lastname: Maeyama
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Naito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects* / Q000639:trends; D055815:Young Adult