title: Maximum Inspiratory Pressure is a Discriminator of Pneumonia in Individuals With Spinal-Cord Injury.
abstract: BACKGROUND
  Respiratory complications remain a major cause of mortality among individuals with spinal-cord injury (SCI). The present study investigated whether respiratory function is a discriminator of pneumonia in individuals with SCI and is aimed to determine the best predictive parameter.
  
  
  METHODS
  This was a retrospective cohort study. Individuals with traumatic SCI, level C3 to T12, complete and incomplete lesions, were included. Data on respiratory function were extracted from medical records. The receiver operating characteristic curve was calculated for each parameter (forced vital capacity, FEV1, peak expiratory flow, and maximum inspiratory and expiratory pressure [PImaxand PEmax]) to determine the discriminator with the largest area under the curve between individuals with and without pneumonia.
  
  
  RESULTS
  Data of 307 subjects were analyzed. PImaxwas identified as the best discriminator between individuals with and without pneumonia, both in motor complete (area under the curve 0.86, 95% CI 0.78-0.93, P < .001) and incomplete individuals (area under the curve 1.0, 95% CI 1.00-1.00, P < .001). In individuals with motor complete lesions, the threshold value for PImaxwas 115% of the lesion-specific reference value (sensitivity 74.4%, specificity 83.4%). In motor incomplete individuals, the PImaxthreshold value was 93.5 cm H2O (sensitivity 100%, specificity 100%).
  
  
  CONCLUSIONS
  PImaxis the best discriminator between spinal cord-injured individuals with versus those without pneumonia. Individuals with a PImaxbelow threshold values are at risk of pneumonia.
authors: Clinical Trial Unit anja.raab@paraplegie.ch.
authors: Anja M
authors: AM
authors: Raab
authors: Clinical Trial Unit.
authors: Jörg
authors: J
authors: Krebs
authors: Institute of Sports Medicine.
authors: Claudio
authors: C
authors: Perret
authors: Ambulatory Services, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors: Franz
authors: F
authors: Michel
authors: Department of Physiology, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors: Maria Te
authors: MT
authors: Hopman
authors: Clinical Trial Unit.
authors: Gabi
authors: G
authors: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D045853:Exhalation / Q000502:physiology; D005260:Female; D005540:Forced Expiratory Flow Rates; D006801:Humans; D008297:Male; D000072277:Maximal Respiratory Pressures / Q000706:statistics & numerical data*; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012119:Respiration; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D014797:Vital Capacity / Q000502:physiology
keywords: paraplegia; predictor; respiratory complications; respiratory strength; risk threshold; tetraplegia