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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

Abstract

Purpose

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

Methods

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.

Results

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.

Conclusion

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.

Keywords

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.

Résumé

Objectif

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.

Méthodes

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.

Résultats

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.

Conclusion

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.

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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

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