The Dose-Response Relationship Between Age and Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury: A Restricted Cubic Spline Function Analysis.

OBJECTIVE: To investigate the continuous relationship between age and tracheostomy in patients with traumatic cervical spinal cord injury (TCSCI). METHODS: This study comprised 689 TCSCI patients in total. The logistic regression and restricted cubic spline analysis was applied to analyze the possible dose-response relationship between age and tracheostomy. The subgroup analysis was performed for the American Spinal Injury Association (ASIA) grade and neurological level of injury. RESULTS: The proportion of patients with the age ≥60 was significantly higher in the tracheostomy group than in the non-tracheostomy group (42.2% vs. 19.6%; P < 0.001). Age ≥60 was independently associated with tracheostomy (total: odds ratio = 3.560, 95% confidence interval: 1.892-6.697; P < 0.001) after adjusting for gender, smoking history, dislocation, respiratory complications, ASIA grade, neurological level of injury, preexisting lung disease, brain injury, and thoracic injury. After the relationship was presented in the subgroup analysis, the restricted cubic spline revealed a nonlinear relationship between age and tracheostomy (P-overall < 0.001 and P-nonlinear = 0.021). CONCLUSIONS: Age and tracheostomy present a dose-response relationship in patients with TCSCI. This finding could help physicians bring assistance in the early identification of tracheostomy and rationalize the allocation of medical resources.

Tracheostomy in traumatic cervical spinal cord injury: Early versus late tracheostomy.

OBJECTIVE: The purpose of this study was to characterize the relationship between predictors and the time of tracheostomy after traumatic cervical spinal cord injury (TCSCI). METHODS: Five hundred twenty-six patients with TCSCI treated between January,2012 and December, 2021 were retrospectively reviewed. Patients were subdivided into two groups: early tracheostomy (≤7 days from initiation of endotracheal intubation) and late tracheostomy. Comparisons between early tracheostomy and late tracheostomy were statistically analyzed. Logistic regression analysis was applied to identify independent predictors of tracheostomy and calculate probability for different grades of combining predictors to predict tracheostomy. Spearman's correlation coefficient was used to evaluate the association between the grade of combining predictors and the time to tracheostomy. RESULTS: Among 526 eligible patients, 63(12.0%) had a tracheostomy performed. Compared with late tracheostomy group, patients in early tracheostomy group had higher ISS, more severe neurological status while fewer In-hospital LOS days and ICU LOS days. By Logistic regression analysis, severe American Spinal Injury Association Impairment Scale (AIS A), the neurological level of injury (NLI>C5), higher Injury Severity Score (ISS>16) and advanced age (over 50 years old) were identified as independent predictors for tracheostomy. Depending on the likelihood of tracheostomy, the combining predictors were graded into five categories. As the value of probability was higher than 50%, Grade I-III made optimistic predictions about tracheostomy. According to Spearman's correlation analysis, early tracheostomy had a strong association with Grade I, while late tracheostomy was closely correlated with Grade III. CONCLUSIONS: Factors related to the decision of tracheostomy were ASIA impairment scale, neurological level of injury, injury severity score and age. The grades of combining predictors could support indication for predicting the time of tracheostomy.

The shoulder abductor strength is a novel predictor of tracheostomy in patients with traumatic cervical spinal cord injury.

BACKGROUND: Early prediction of tracheostomy in traumatic cervical spinal cord injury (TCSCI) patients is often difficult. This study aims to clarify the association between shoulder abductor strength (SAS) and tracheostomy in patients with TCSCI. METHODS: We retrospectively analyzed 513 TCSCI patients who were treated in our hospital. All patients were divided into a tracheostomy group and a non-tracheostomy group. The SAS was assessed using the Medical Research Council (MRC) Scale for Muscle Strength grading. Potential predictors were assessed for their association with tracheostomy in patients. A nomogram was developed based on multivariable logistic regression analysis (MLRA) to visualize the predictive ability of the SAS. Validation of the nomogram was performed to judge whether the nomogram was reliable for visual analysis of the SAS. Receiver operating characteristics curve, specificity, and sensitivity were also performed to assess the predictive ability of the SAS. RESULTS: The proportion of patients with the SAS grade 0-2 was significantly higher in the tracheostomy group than in the non-tracheostomy group (88.1% vs. 54.8%, p = 0.001). The SAS grade 0-2 was identified as a significant predictor of the tracheostomy (OR: 4.505; 95% CI: 2.080-9.758; p = 0.001). Points corresponding to both the SAS grade 0-2 and the neurological level of injury at C2-C4 were between 60 and 70 in the nomogram. The area under the curve for the SAS grade 0-2 was 0.692. The sensitivity of SAS grade 0-2 was 0.239. The specificity of SAS grade 0-2 was 0.951. CONCLUSIONS: SAS is a novel predictor of tracheostomy in patients after TCSCI. The SAS grade 0-2 had a good predictive ability of tracheostomy.

A Nomogram Model for Prediction of Tracheostomy in Patients With Traumatic Cervical Spinal Cord Injury.

OBJECTIVE: To develop a nomogram for the prediction of tracheostomy in patients with traumatic cervical spinal cord injury (TCSCI). METHODS: A total of 689 TCSCI patients were included in our study. First, the variable selection was performed using between-group comparisons and LASSO regression analysis. Second, a multivariate logistic regression analysis (MLRA) with a step-by-step method was performed. A nomogram model was developed based on the MLRA. Finally, the model was validated on the training set and validation set. RESULTS: The nomogram prediction model incorporated 5 predictors, including smoking history, dislocation, thoracic injury, American Spinal Injury Association (ASIA) grade, and neurological level of injury (NLI). The area under curve in the training group and in the validation group were 0.883 and 0.909, respectively. The Hosmer-Lemeshow test result was p = 0.153. From the decision curve analysis curve, the model performed well and was feasible to make beneficial clinical decisions. CONCLUSION: The nomogram combining dislocation, thoracic injury, ASIA grade A, NLI, and smoking history was validated as a reliable model for the prediction of tracheostomy.