Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury

  • Andrew R. Claxton
  • David T. Wong
  • Frances Chung
  • Michael G. Fehlings
Reports of Investigation



The objective of this study was to identify predictors of death and mechanical ventilation in patients with traumatic cervical spinal cord injury.


From 1981 to 1994, 72 patients with traumatic cervical spinal cord injury resulting in neurological deficits were identified in this retrospective study. For each patient, neurological and associated injuries, physiological variables, complications, hospital mortality and the need for mechanical ventilation were recorded. Univariate and multivariate logistic regression analyses were done to identify predictors of mortality and the need for mechanical ventilation.


Fifteen patients (21%) died in The flirt three months after injury. Univariate analyses identified age, heart disease, neurological level at C4 and above, GCS ≤ 13, forced vital capacity and cough, to be associated with mortality. Murtivanate logistic regression identified age (P = 0.01 ), neurological level (P = 0.03) and GCS (P = 0.05) as independent predictors of mortality. In 41 patients (57%), the lungs were mechanically ventilated. Univariate analyses identified The following predictors of the need for mechanical ventilation: neurological level at C5 and above, complete cord lesions, copious sputum, pneumonia and lung collapse. Murtivariate logistic regression identified copious sputum (P = 0.01 ) and pneumonia (P = 0.01 ) as independent predictors of the need for mechanical ventilation.


Age, neurological level and GCS are independent predictors of mortality in patients with traumatic cervical spinal cord injury, Copious sputum and pneumonia are independent predictors of the need for mechanical ventilation.


Mechanical Ventilation Spinal Cord Injury Glasgow Coma Scale Spinal Cord Lesion Cervical Spinal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Le but de cette étude était d’identifier des éléments pronostiques de décès ou de ventilation mécanique prolongée chez des patients souffrant de traumatisme de la moëlle cervicale.


Dans cette étude rétrospective s’étendant de 1981 à 1994, on a identifié 72 patients souffrant de traumatisme de la moëlle cervicale entraînant des déficits neurologiques. Pour chaque patient, on a compilé les blessures neurologiques et autres, les variables physiologiques, les complications, la mortalité à l’hôpital et le besoin de ventilation mécanique. On a utilisé des analyses de régression logistique à variables unique ou multiples pour identifier les éléments pronostiques de décès ou de la nécessité de ventilation mécanique prolongée.


Quinze patients (21%) sont décédés durant les trois premiers mois après le traumatisme. Selon des analyses à variable unique, la mortalité était en relation avec l’âge, la maladie cardiaque, le niveau de lésion neurologique à C4 ou plus haut, le score de Glasgow ≤ 13, la capacité vitale et la capacité de tousser. La régression logistique à variables multiples identifie comme éléments indépendants pronostiques de mortalité, l’âge (P = 0,01), le niveau de lésion neurologique (P = 0,03) et le score de Glasgow (P = 0,05). Pour 41 patients (57%), on a utilisé la ventilation mécanique. Les analyses à variable unique ont identifié comme éléments pronostiques de ventilation mécanique : un niveau de lésion neurologique à C5 et plus haut, une section complète de la moëlle, des sécrétions abondantes, une pneumonie et un collapsus pulmonaire. La régression logistique à variables multiples identifie les sécrétions abondantes (P < 0,01) et la pneumonie (P = 0,01) comme éléments indépendants pronostiques de la nécessité d’une ventilation mécanique.


Chez les patiente présentant une lésion traumatique de la moëlle cervicale, l’âge, le niveau de la lésion et le score de Glasgow sont des éléments pronostiques indépendants quant au décès, alors que des sécrétions bronchiques abondantes et des pneumonies prédisent le besoin de ventilation mécanique.


  1. 1.
    Kraus JE. Epidemiologic features of head and spinal cord injury. Adv Neurol 1978; 19: 261–79.PubMedGoogle Scholar
  2. 2.
    Ledsome JR, Sharp JM. Pulmonary function in acute cervical cord injury. Am Rev Respir Dis 1981; 124: 41–1.PubMedGoogle Scholar
  3. 3.
    Ohry A, Molho M, Rozin R. Alterations of pulmonary function in spinal cord injured patients. Paraplegia 1975; 13: 101–8.PubMedGoogle Scholar
  4. 4.
    Silver JR, Gibbon NOK. Prognosis in tetraplegia. BMJ 1968; 4: 79–83.PubMedCrossRefGoogle Scholar
  5. 5.
    Bellamy R, Pitts FW, Stauffer ES. Respiratory complications in traumatic quadriplegia. J Neurosurg 1973; 39: 596–600.PubMedGoogle Scholar
  6. 6.
    Kraus FJ, Frautti CE, Borhani NO, Riggins RS. Survival with acute spinal-cord injury. Journal of Chronic Disease 1979; 32: 269–83.CrossRefGoogle Scholar
  7. 7.
    Mesard L, Carmody A, Mannarino E, Ruge D. Survival after spinal cord trauma. A life table analysis. Arch Neurol 1978; 35: 78–83.PubMedGoogle Scholar
  8. 8.
    DeVivo MJ, Kartus PL, Stover SL, Rutt RD, Fine PR. Seven-year survival following spinal cord injury. Arch Neurol 1987; 44: 872–5.PubMedGoogle Scholar
  9. 9.
    DeVivo MJ, Stover SL, Black KJ. Prognostic factors for 12-year survival after spinal cord injury. Arch Phys Med Rehabil 1992; 73: 156–62.PubMedGoogle Scholar
  10. 10.
    DeVivo MJ, Ivie CS III. Life expectancy of ventilatordependent persons with spinal cord injuries. Chest 1995; 108: 226–32.PubMedCrossRefGoogle Scholar
  11. 11.
    Daverat P, Gagnon M, Dartigues JF, Maztmx JM, Barat M. Initial factors predicting survival in patients with a spinal cord injury. J Neurol Neurosurg Psychiatry 1989; 52: 403–6.PubMedCrossRefGoogle Scholar
  12. 12.
    The International Classification of Disease, 9th revision, clinical modification: ICD-9-CM. Washington: U.S. Dept of Health and Human Services, 1986: 742, 743, 832.Google Scholar
  13. 13.
    International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association, Chicago, Illinois: Ditunno JF, 1992.Google Scholar
  14. 14.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis of acute organ-system failure. Ann Surg 1985; 202: 685–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons, 1989: 25–37.Google Scholar
  16. 16.
    Wicks AB, Menter RR. Long-term outlook in quadriplegic patients with initial ventilator dependency. Chest 1986; 90: 406–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Boyd CR, Toison MA, Copes WS. Evaluating trauma Care the TRISS method. J Trauma 1987; 27: 370–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Demling R, Reissen R. Pulmonary dysfunction after cerebral Injury. Crit Care Med 1990; 18: 768–74.PubMedCrossRefGoogle Scholar
  19. 19.
    McMichan JC, Michel L, Westbrook PR. Pulmonary dysfunction following traumatic quadriplegia. JAMA 1980; 243: 528–31.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anaesthesiologists 1998

Authors and Affiliations

  • Andrew R. Claxton
    • 1
  • David T. Wong
    • 1
  • Frances Chung
    • 1
  • Michael G. Fehlings
    • 2
  1. 1.Department of Anaesthesia, The Division of Neurosurgery and Spinat ProgramUniversity of TorontoTorontoCanada
  2. 2.Department of Anaesthesia, The Toronto Hospital, Western DivisionUniversity of TorontoTorontoCanada

Personalised recommendations