Incidence and risk factors of pneumonia following acute traumatic cervical spinal cord Injury

Abstract

Objectives

To elucidate the incidence and risk factors for pneumonia after acute traumatic cervical spinal cord injury (CSCI)

Design

Retrospective cohort study.

Setting: Spinal injuries center in Japan.

Participants: Of 184 individuals who were admitted within 2 weeks after acute traumatic cervical spinal injuries, 167 individuals who met the criteria were included in this study.

Interventions: The occurrence of pneumonia, degree of dysphagia using the Dysphagia Severity Scale, patient age, history of smoking, presence of tracheostomy, vital capacity, level of injury, and the American Spinal Injury Association Impairment Scale (AIS) 2 weeks after injury were assessed.

Outcomes: Incidence of pneumonia were analyzed. Moreover, the risk factors of pneumonia were evaluated using logistic regression analysis.

Results

From the 167 individuals who met the criteria, 30 individuals (18%) had pneumonia; in 26 (87%) of these individuals, pneumonia was aspiration related, defined as Dysphagia Severity Scale ≤ 4. The median occurrence of aspiration pneumonia was 11.5 days after injury. A logistic regression analysis revealed that severe AIS and severe Dysphagia Severity Scale scores were significant risk factors of pneumonia after CSCI.

Conclusions

It was highly likely that the pneumonias following CSCI were related to aspiration based on the Dysphagia Severity Scale. In addition, most of the patients developed aspiration pneumonia within 1 month after injury. Aspiration and severe paralysis were significant risk factors for pneumonia. The treatment of dysphagia in the acute phase should be considered an important indicator to prevent pneumonia.

Keywords:

• Pneumonia
• Cervical spinal cord injury
• Dysphagia
• Paralysis

Acknowledgments

None

Conflict of interest

No potential conflict of interest was reported by the author(s).

Statement of ethics

The study protocol was approved by the Institutional Review Board of the Spinal Injuries Center, and all participants provided written informed consent before participating in the study. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during this research.

Patient consent for images or information used in the manuscript

Not applicable.

Authors’ contributions

TH was responsible for designing the study, writing the protocol and report, extracting and analyzing data, screening potential eligible studies, interpreting results, updating reference lists, and creating the “Summary of Findings” tables. YF was responsible for conducting the literature search, extracting and analyzing data, and screening potential eligible studies. OK contributed to interpreting the results. YY contributed to designing the study and interpreting the results. KK contributed to designing the study and interpreting the results. HS contributed to designing the study. MM contributed to interpreting the results. YM contributed to interpreting the results. KK contributed to interpreting the results. KY contributed to interpreting the results. HK contributed to designing the study and interpreting the results. TM contributed to interpreting the results and providing feedback on the report.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The works of Dr. Hayashi were supported by JSPS KAKENHI Grant Numbers 19K19861, and a medical research grant on traffic accidents from The General Insurance Association of Japan.