Incidence and clinical predictors for tracheostomy after cervical spinal cord injury: A national trauma databank review

Background: The purpose of this study was to determine the incidence and identify clinical predictors for the need for tracheostomy after cervical spinal cord injury (CSCI). Methods: The National Trauma Databank version 7.0 (2002-2006) was used to identify all patients who sustained a CSCI. Patients with severe traumatic brain injury (TBI) were excluded. Demographics, clinical data, and outcomes were abstracted. Patients requiring tracheostomy were compared with those who did not require tracheostomy. Logistic regression analysis was used to identify independent predictors for the need of tracheostomy. Results: There were 5,265 eligible patients. Of these, 1,082 (20.6%) required tracheostomy and 4,174 (79.4%) did not. The majority patients were men and blunt trauma predominated. Patients requiring tracheostomy had a higher Injury Severity Score (ISS) (33.5 ± 17.7 vs. 24.4 ± 16.2, p < 0.001) and required intubation more frequently on scene and Emergency Department (ED) (4.2 vs. 1.4%, p < 0.001 and 31.1 vs. 7.9%, p < 0.001, respectively). Patients requiring tracheostomy had higher rates of complete CSCI at C1-C4 (18.2 vs. 8.4%, p < 0.001) and C5-C7 levels (37.8 vs. 16.9%, p < 0.001). Patients requiring tracheostomy had more ventilation days, longer intensive care unit and hospital lengths of stay, but lower mortality. Intubation on scene or ED, complete CSCI at C1-C4 or C5-C7 levels, ISS ≥16, facial fracture, and thoracic trauma were identified as independent predictors for the need of tracheostomy. Conclusion: After CSCI, a fifth of patients will require tracheostomy. Intubation on scene or ED, complete CSCI at C1-C4 or C5-C7 levels, ISS ≥16, facial fracture, and thoracic trauma were independently associated with the need for tracheostomy.