Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis
Introduction: Pneumonia is one of the leading causes of acute- and chronic-phase mortality in patients with cervical spinal cord injury (CSCI) with quadriplegia. The risk factors for chronic-phase pneumonia recurrence in CSCI are still unknown. This study aimed to investigate the incidence of pneumo...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The Japanese Society for Spine Surgery and Related Research
2023-07-01
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| Series: | Spine Surgery and Related Research |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/7/4/7_2022-0254/_pdf/-char/en |
| _version_ | 1797659805406461952 |
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| author | Chikara Ushiku Kota Suda Takehiro Michikawa Satoko Matsumoto Harmon Miki Komatsu Osahiko Tsuji Masahiko Takahata Mitsuru Saito Norimasa Iwasaki Akio Minami |
| author_facet | Chikara Ushiku Kota Suda Takehiro Michikawa Satoko Matsumoto Harmon Miki Komatsu Osahiko Tsuji Masahiko Takahata Mitsuru Saito Norimasa Iwasaki Akio Minami |
| author_sort | Chikara Ushiku |
| collection | DOAJ |
| description | Introduction: Pneumonia is one of the leading causes of acute- and chronic-phase mortality in patients with cervical spinal cord injury (CSCI) with quadriplegia. The risk factors for chronic-phase pneumonia recurrence in CSCI are still unknown. This study aimed to investigate the incidence of pneumonia in the chronic phase after injury and to identify its risk factors.
Methods: This retrospective clinical observational study included patients with CSCI with American Spinal Injury Association Impairment Scale grades of A or B admitted to our center within 72 h of CSCI injury who started treatment and were available for follow-up for at least 90 days. The patients were assessed for incidences of pneumonia and its associations with clinical characteristics, including risk factors at the time of injury. Patients in whom pneumonia developed within 30 days postadmission and those after 30 days of hospitalization were comparatively examined using univariate and multivariate analyses.
Results: Pneumonia occurred in 36% of the 69 enrolled patients throughout the study period and in 20% of all patients after 30 days of hospitalization. Multivariate analysis of risk factors for pneumonia showed that atelectasis (adjusted OR [aOR], 95% confidence interval [CI]: 4.9, 1.2-20.0), enteral feeding (aOR [95% CI]: 13.3 [3.0-58.9]), mechanical ventilation (aOR [95% CI]: 4.0 [1.0-15.0]), and tracheotomy (aOR [95% CI]: 14.6 [2.3-94.6]) within 30 days of admission were significantly associated with the occurrence of pneumonia even after 30 days of hospitalization.
Conclusions: The risk factors for developing pneumonia in the chronic phase were atelectasis, enteral feeding, mechanical ventilation, and tracheotomy within 30 days of hospitalization. This study suggests that treatment of atelectasis, long-term respiratory muscle rehabilitation, and training to improve swallowing function are essential to prevent the recurrence of pneumonia after 30 days of hospitalization. |
| first_indexed | 2024-03-11T18:20:32Z |
| format | Article |
| id | doaj.art-dc8c6f606f7f4221bee1575962befac3 |
| institution | Directory Open Access Journal |
| issn | 2432-261X |
| language | English |
| last_indexed | 2024-03-11T18:20:32Z |
| publishDate | 2023-07-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj.art-dc8c6f606f7f4221bee1575962befac32023-10-16T00:32:24ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2023-07-017433334010.22603/ssrr.2022-02542022-0254Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor ParalysisChikara Ushiku0Kota Suda1Takehiro Michikawa2Satoko Matsumoto Harmon3Miki Komatsu4Osahiko Tsuji5Masahiko Takahata6Mitsuru Saito7Norimasa Iwasaki8Akio Minami9Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterDepartment of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterDepartment of Environmental and Occupational Health, School of Medicine, Toho UniversityDepartment of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterDepartment of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterDepartment of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterDepartment of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopedic Surgery, The Jikei University School of MedicineDepartment of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido UniversityDepartment of Orthopedic Surgery, Hokkaido Spinal Cord Injury CenterIntroduction: Pneumonia is one of the leading causes of acute- and chronic-phase mortality in patients with cervical spinal cord injury (CSCI) with quadriplegia. The risk factors for chronic-phase pneumonia recurrence in CSCI are still unknown. This study aimed to investigate the incidence of pneumonia in the chronic phase after injury and to identify its risk factors. Methods: This retrospective clinical observational study included patients with CSCI with American Spinal Injury Association Impairment Scale grades of A or B admitted to our center within 72 h of CSCI injury who started treatment and were available for follow-up for at least 90 days. The patients were assessed for incidences of pneumonia and its associations with clinical characteristics, including risk factors at the time of injury. Patients in whom pneumonia developed within 30 days postadmission and those after 30 days of hospitalization were comparatively examined using univariate and multivariate analyses. Results: Pneumonia occurred in 36% of the 69 enrolled patients throughout the study period and in 20% of all patients after 30 days of hospitalization. Multivariate analysis of risk factors for pneumonia showed that atelectasis (adjusted OR [aOR], 95% confidence interval [CI]: 4.9, 1.2-20.0), enteral feeding (aOR [95% CI]: 13.3 [3.0-58.9]), mechanical ventilation (aOR [95% CI]: 4.0 [1.0-15.0]), and tracheotomy (aOR [95% CI]: 14.6 [2.3-94.6]) within 30 days of admission were significantly associated with the occurrence of pneumonia even after 30 days of hospitalization. Conclusions: The risk factors for developing pneumonia in the chronic phase were atelectasis, enteral feeding, mechanical ventilation, and tracheotomy within 30 days of hospitalization. This study suggests that treatment of atelectasis, long-term respiratory muscle rehabilitation, and training to improve swallowing function are essential to prevent the recurrence of pneumonia after 30 days of hospitalization.https://www.jstage.jst.go.jp/article/ssrr/7/4/7_2022-0254/_pdf/-char/encervical spinal cord injurycomplete motor paralysischronic phasepneumonia |
| spellingShingle | Chikara Ushiku Kota Suda Takehiro Michikawa Satoko Matsumoto Harmon Miki Komatsu Osahiko Tsuji Masahiko Takahata Mitsuru Saito Norimasa Iwasaki Akio Minami Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis Spine Surgery and Related Research cervical spinal cord injury complete motor paralysis chronic phase pneumonia |
| title | Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis |
| title_full | Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis |
| title_fullStr | Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis |
| title_full_unstemmed | Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis |
| title_short | Incidence and Risk Factors for Pneumonia in the Chronic Phase of Cervical Spinal Cord Injury with Complete Motor Paralysis |
| title_sort | incidence and risk factors for pneumonia in the chronic phase of cervical spinal cord injury with complete motor paralysis |
| topic | cervical spinal cord injury complete motor paralysis chronic phase pneumonia |
| url | https://www.jstage.jst.go.jp/article/ssrr/7/4/7_2022-0254/_pdf/-char/en |
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