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

Tetsuo Hayashi; Yuichi Fujiwara; Osamu Kawano; Yuzo Yamamoto; Kensuke Kubota; Hiroaki Sakai; Muneaki Masuda; Yuichiro Morishita; Kazu Kobayakawa; Kazuya Yokota; Hironari Kaneyama; Takeshi Maeda

doi:10.1080/10790268.2022.2027323

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

J Spinal Cord Med. 2023 Sep;46(5):725-731. doi: 10.1080/10790268.2022.2027323. Epub 2022 Feb 2.

Authors

Affiliations

¹ Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
² Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
³ Nursing Department, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
⁴ Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

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: Cervical spinal cord injury; Dysphagia; Paralysis; Pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cervical Cord* / injuries
Cervical Vertebrae / injuries
Deglutition Disorders* / epidemiology
Deglutition Disorders* / etiology
Humans
Incidence
Infant, Newborn
Neck Injuries* / complications
Pneumonia* / epidemiology
Pneumonia* / etiology
Pneumonia, Aspiration* / complications
Retrospective Studies
Risk Factors
Spinal Cord Injuries* / complications
Spinal Cord Injuries* / epidemiology
Spinal Injuries*

Grants and 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.