Predictors of pulmonary complications in blunt traumatic spinal cord injury.

dc.contributor.author

Aarabi, Bizhan

dc.contributor.author

Harrop, James S

dc.contributor.author

Tator, Charles H

dc.contributor.author

Alexander, Melvin

dc.contributor.author

Dettori, Joseph R

dc.contributor.author

Grossman, Robert G

dc.contributor.author

Fehlings, Michael G

dc.contributor.author

Mirvis, Stuart E

dc.contributor.author

Shanmuganathan, Kathirkamanathan

dc.contributor.author

Zacherl, Katie M

dc.contributor.author

Burau, Keith D

dc.contributor.author

Frankowski, Ralph F

dc.contributor.author

Toups, Elizabeth

dc.contributor.author

Shaffrey, Christopher I

dc.contributor.author

Guest, James D

dc.contributor.author

Harkema, Susan J

dc.contributor.author

Habashi, Nader M

dc.contributor.author

Andrews, Penny

dc.contributor.author

Johnson, Michele M

dc.contributor.author

Rosner, Michael K

dc.date.accessioned

2023-08-30T00:27:07Z

dc.date.available

2023-08-30T00:27:07Z

dc.date.issued

2012-09

dc.date.updated

2023-08-30T00:27:06Z

dc.description.abstract

Object

Pulmonary complications are the most common acute systemic adverse events following spinal cord injury (SCI), and contribute to morbidity, mortality, and increased length of hospital stay (LOS). Identification of factors associated with pulmonary complications would be of value in prevention and acute care management. Predictors of pulmonary complications after SCI and their effect on neurological recovery were prospectively studied between 2005 and 2009 at the 9 hospitals in the North American Clinical Trials Network (NACTN).

Methods

The authors sought to address 2 specific aims: 1) define and analyze the predictors of moderate and severe pulmonary complications following SCI; and 2) investigate whether pulmonary complications negatively affected the American Spinal Injury Association (ASIA) Impairment Scale conversion rate of patients with SCI. The NACTN registry of the demographic data, neurological findings, imaging studies, and acute hospitalization duration of patients with SCI was used to analyze the incidence and severity of pulmonary complications in 109 patients with early MR imaging and long-term follow-up (mean 9.5 months). Univariate and Bayesian logistic regression analyses were used to analyze the data.

Results

In this study, 86 patients were male, and the mean age was 43 years. The causes of injury were motor vehicle accidents and falls in 80 patients. The SCI segmental level was in the cervical, thoracic, and conus medullaris regions in 87, 14, and 8 patients, respectively. Sixty-four patients were neurologically motor complete at the time of admission. The authors encountered 87 complications in 51 patients: ventilator-dependent respiratory failure (26); pneumonia (25); pleural effusion (17); acute lung injury (6); lobar collapse (4); pneumothorax (4); pulmonary embolism (2); hemothorax (2), and mucus plug (1). Univariate analysis indicated associations between pulmonary complications and younger age, sports injuries, ASIA Impairment Scale grade, ascending neurological level, and lesion length on the MRI studies at admission. Bayesian logistic regression indicated a significant relationship between pulmonary complications and ASIA Impairment Scale Grades A (p = 0.0002) and B (p = 0.04) at admission. Pulmonary complications did not affect long-term conversion of ASIA Impairment Scale grades.

Conclusions

The ASIA Impairment Scale grade was the fundamental clinical entity predicting pulmonary complications. Although pulmonary complications significantly increased LOS, they did not increase mortality rates and did not adversely affect the rate of conversion to a better ASIA Impairment Scale grade in patients with SCI. Maximum canal compromise, maximum spinal cord compression, and Acute Physiology and Chronic Health Evaluation-II score had no relationship to pulmonary complications.
dc.identifier.issn

1547-5654

dc.identifier.issn

1547-5646

dc.identifier.uri

https://hdl.handle.net/10161/28873

dc.language

eng

dc.publisher

Journal of Neurosurgery Publishing Group (JNSPG)

dc.relation.ispartof

Journal of neurosurgery. Spine

dc.relation.isversionof

10.3171/2012.4.aospine1295

dc.subject

Spinal Cord

dc.subject

Humans

dc.subject

Lung Diseases

dc.subject

Spinal Cord Injuries

dc.subject

Respiratory Function Tests

dc.subject

Treatment Outcome

dc.subject

Prospective Studies

dc.subject

Predictive Value of Tests

dc.subject

Age Factors

dc.subject

Adolescent

dc.subject

Adult

dc.subject

Aged

dc.subject

Aged, 80 and over

dc.subject

Middle Aged

dc.subject

Female

dc.subject

Male

dc.title

Predictors of pulmonary complications in blunt traumatic spinal cord injury.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

38

pubs.end-page

45

pubs.issue

1 Suppl

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

17

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
j-neurosurg-spine-article-p38.pdf
Size:
1.07 MB
Format:
Adobe Portable Document Format