RISK FACTORS PREDICTIVE OF TRACHEOSTOMY IN SPINAL CORD INJURY PATIENTS

Objectives: Spinal cord injuries (SCI) cause significant respiratory compromise, and increase the probability of prolonged intubation and tracheostomy. Previous work has established correlations between SCI and the need for tracheostomy, but no consensus has been reached regarding specific risk factors that increase the chances of tracheostomy. In this study, we investigate the correlation between SCI and tracheostomy, and determine the association between possible risk factors and the need for tracheostomy.

Methods: A retrospective chart review was performed and included all trauma patients age 18 and older who presented to our level I trauma center between the years of 2015 and 2020 with a diagnosed spinal cord injury. Patients with a preexisting SCI, those who died prior to an examination documenting neurological deficit, and those with missing data were excluded from the study. All individual patient charts were reviewed for variables of interest. The primary outcome measured was need for tracheostomy. Secondary outcomes included mortality, infectious complications, and length of stay. We used Chi squared testing for statistical comparisons between groups and student t-testing for continuous variables.

Results: We identified 151 patients over the timeframe of our study; 121 males and 30 females. 39 patients (26%) required tracheostomy during their hospitalization, with no differences between genders. 41.5% of patients with a complete SCI required tracheostomy compared to 17.3% of patients with incomplete injuries (P < 0.05). There was no difference in requirement for tracheostomy between patients who required operative fixation versus non-operative treatment. Smoking was not a risk factor for need for tracheostomy, nor was age or obesity (assessed by BMI). However, severe burden of injury as measured by Injury Severity Score (ISS) and diabetes were independent risk factors for tracheostomy placement. Overall mortality was 11.3%, and was not statistically significant between patients who underwent tracheostomy or did not. The pneumonia rate was 26%, with 69.2% of patients who had a trach placed experiencing at least one pneumonia compared to 10.7% of patients who did not require a tracheostomy. Bacteremia and UTI were also more common in Trach patients. LOS was longer in trach patients; 26.9 days vs. 14 days (P < 0.05).

Conclusion: Patients with a complete SCI are at much higher risk of requiring a tracheostomy after their injury. Other independent risk factors include ISS and the presence of diabetes. Further work should focus on potential risk scoring systems to identify these patients early in their hospitalization, to allow for early tracheostomy.