Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury

Abstract INTRODUCTION Advances in treatment of traumatic cervical spinal cord injury with fracture (TCSCIF) have led to significant improvements in clinical outcomes; however, progress in healthcare is seldom ubiquitous across demographic groups. We explored if disparities in treatment and outcome after TCSCIF exist across race and socioeconomic status. METHODS We queried the Nationwide Inpatient Sample database from 1998 to 2009 for TCSCIF hospitalizations. Multivariate analysis was used to identify the correlation between socioeconomic status and race to treatment type and outcome. RESULTS There were 21 985 admissions for TCSCIF. In all 66.9% had a favorable discharge disposition. In-hospital mortality rate was 12.5%. In all 43.7% underwent surgery. Overall, surgery was associated with lower in-hospital mortality (OR 0.30, 95% CI 0.27-0.34, P < .01) and better discharge disposition (OR 0.68, 95% CI 0.62-0.74, P < .01) vs nonsurgical or no intervention. Controlling for race and socioeconomic status demonstrated higher status (HS) non-Caucasians had lower odds of receiving surgery than HS Caucasians (OR 0.89, 95% CI 0.81-0.97, P = .01). LSES non-Caucasians had lower odds of receiving surgery than HS Caucasians (OR 0.83, 95% CI 0.73-0.94, P < .01). HS non-Caucasians had lower odds of receiving surgery than LSES Caucasians (OR 0.87, 95% CI 0.77-0.99, P = .03). LSES non-Caucasians had lower odds of receiving surgery than LSES Caucasians (OR 0.82, 95% CI 0.71-0.94, P = .01). For favorable discharge status HS non-Caucasians, LSES non-Caucasians, and LSES Caucasians all had lower odds of favorable discharge compared to HS Caucasians (OR 0.83, 95% CI 0.73-0.95, P = .01/OR 0.69, 95% CI 0.59-0.81, P < .01/OR 0.75, 95% CI 0.66-0.85, P < .01), respectively. CONCLUSION In our multivariate model that controlled for race and socioeconomic status in the setting of TCSCIF, race (but not socioeconomic status) was a factor in receiving surgery and both race and LSES impacted favorable discharge.

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Pulmonary Rehabilitation throughout the Weaning from Mechanical Ventilation for Complete Cervical Spinal Cord Injury: A Case Report

10.22514/sv.2020.16.0058 ◽

2020 ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Mechanical Ventilation ◽

Cervical Spinal Cord ◽

Respiratory Muscles ◽

Rehabilitation Program ◽

Cervical Spinal Cord Injury ◽

Weaning From Mechanical Ventilation ◽

Impedance Tomography ◽

Cord Injury

The aim of this report was to present a tailored program of weaning from mechanical ventilation successfully. This program was developed for the ventilator-dependent patient with spinal cord injury (SCI) and especially targeting the respiratory muscles. A 48-year old male had a car accident on 25 May 2019 and his limb muscle strengths were severely impaired. He was diagnosed with complete cervical spinal cord injury (level C4), difficult-to-wean. Electrical impedance tomography was used to direct the rehabilitation program. Besides, passive activities (stretching of the intercostal muscles, bed tilting, and passive movement of the scapula and the proximal end of the upper limbs) and active training (various diaphragmatic facilitation techniques) were applied for inspiratory muscle training. The patient was successfully weaned from mechanical ventilation and discharged from the hospital. The individualization of rehabilitation program was demonstrated before, during, and after weaning for the SCI patient. Rehabilitation program especially targeting the respiratory muscles would facilitate the weaning process for complete spinal cord injury.

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