Analysis of the risk factors for tracheostomy and decannulation after traumatic cervical spinal cord injury in an aging population

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY Spinal cord Pub Date : 2019-05-10 DOI:10.1038/s41393-019-0289-x
Takayuki Higashi, Hideto Eguchi, Yusuke Wakayama, Masakatsu Sumi, Tomoyuki Saito, Yutaka Inaba
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引用次数: 15

Abstract

Retrospective study. To investigate the risk factors associated with tracheostomy after traumatic cervical spinal cord injury (CSCI) and to identify factors associated with decannulation in an aging population. Advanced critical care and emergency center in Yokohama, Japan. Sixty-five patients over 60 years with traumatic CSCI treated between January 2010 and June 2017 were enrolled. The parameters analyzed were age, sex, American Spinal Injury Association impairment scale score (AIS) at admission and one year after injury, neurological level of injury (NLI), injury mechanism, Charlson’s comorbidity index (CCI), smoking history, radiological findings, intubation at arrival, treatment choice, length of intensive care unit (ICU) stay, tracheostomy rate, improvement of AIS, decannulation rate, and mortality after one year. The study included 48 men (74%; mean age 72.8 ± 8.3 years). Twenty-two (34%), 10 (15%), 24 (37%), and 9 (14%) patients were classified as AIS A, B, C, and D, respectively. The tracheostomy group showed significantly more severe degree of paralysis, more patients with major fractures or dislocations, more operative treatment, longer ICU stay, poorer improvement in AIS score after one year and higher rate of intubation at arrival. AIS A at injury was the most significant risk factor for tracheostomy. The non-decannulation group had a significantly higher mortality. The risk factor for failure of decannulation was CCI. Risk factors for tracheostomy after traumatic CSCI were AIS A, operative treatment, major fracture/dislocation, and intubation at arrival. The only factor for failure of decannulation was CCI.
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外伤性颈椎脊髓损伤后气管切开和拔管的风险因素分析(老年人群
回顾性研究。调查与外伤性颈脊髓损伤(CSCI)后气管切开相关的风险因素,并确定与老年人群中取消气管切开相关的因素。研究地点:日本横滨市高级重症监护和急救中心。65 名 60 岁以上的外伤性 CSCI 患者在 2010 年 1 月至 2017 年 6 月期间接受了治疗。分析的参数包括年龄、性别、入院时和受伤一年后的美国脊柱损伤协会损伤量表评分(AIS)、神经损伤程度(NLI)、损伤机制、查尔森合并症指数(CCI)、吸烟史、放射学检查结果、入院时插管情况、治疗选择、重症监护室(ICU)住院时间、气管切开率、AIS改善情况、拔管率以及一年后的死亡率。研究包括 48 名男性(74%;平均年龄为 72.8 ± 8.3 岁)。22例(34%)、10例(15%)、24例(37%)和9例(14%)患者分别被归类为AIS A、B、C和D。气管切开组患者的瘫痪程度明显更严重,有严重骨折或脱臼的患者更多,手术治疗更多,重症监护室住院时间更长,一年后 AIS 评分改善较差,到达时插管率更高。受伤时的 AIS A 是气管切开的最重要风险因素。未行气管切开术组的死亡率明显更高。气管切开失败的风险因素是CCI。外伤性 CSCI 后进行气管切开术的风险因素是 AIS A、手术治疗、重大骨折/脱位和到达时插管。唯一导致气管切开失败的因素是CCI。
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来源期刊
Spinal cord
Spinal cord 医学-临床神经学
CiteScore
4.50
自引率
9.10%
发文量
142
审稿时长
2 months
期刊介绍: Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews. Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.
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