Analysis of risk factors for tracheostomy in cervical spinal cord injury and predictive role of key muscle strength for tracheostomy / 中华创伤杂志

ABSTRACT

Objective:To investigate the risk factors of tracheotomy after cervical spinal cord injury (CSCI) and the predictive role of key muscle strength in guiding bedside tracheotomy.Methods:A retrospective case-control study was used to analyze the clinical data of 294 patients with CSCI admitted to Xinqiao Hospital of Army Medical University from January 2009 to December 2013, including 243 males and 51 females, with the age range of 10-82 years [(48.9±14.7)years]. A total of 52 patients treated with tracheotomy (tracheotomy group), while 242 patients did receive tracheotomy (non-tracheotomy group). The indices were collected and compared between groups, including demographic data (gender, age, smoking history, cause of injury), injury severity data [level of injury, combined injury, cervical dislocation, American Spinal Cord Injury Association (ASIA) classification], and key muscle function strength [shrug (trapezius), shoulder abduction (deltoid) and elbow flexion (biceps)]. The risk factors affecting the tracheotomy were identified by the univariate logistic regression analysis and binary logistic regression analysis. The independent risk factor for tracheostomy and predictive role of key muscle strength was determined by the multiple logistic regression analysis.Results:Smoking history, falling injury, cervical dislocation, C 2-C 4 AISA scale A, shoulder-shrugging muscle strength, shoulder abduction muscle strength and elbow flexion strength were significantly different between groups ( P<0.05). Through the binary logistic regression analysis, it was preliminarily concluded that smoking history, traffic injury, falling injury, cervical dislocation, C 2-C 4 AISA scale A, and C 5-C 8 AISA scale A were statistically significant between groups ( P<0.05). The multiple logistic regression analysis showed smoking history( OR=2.27), cervical dislocation( OR=3.70) and C 2-C 4 AISA scale A ( OR=8.31) were significantly related to tracheostomy ( P<0.05). The multiple logistic regression analysis showed shoulder-shrugging muscle strength grade 3 and below and shoulder abduction muscle strength grade 2 and below had significant correlations with CSCI patients who required tracheotomy ( P<0.05). Conclusions:C 2-C 4 AISA scale A, cervical dislocation and smoking history are independent risk factors for determining whether the CSCI patients require tracheostomy. Shoulder-shrugging muscle strength grade 3 and below and shoulder abduction muscle strength grade 2 and below can be used to differentiate the bedside tracheotomy.