Prognostic impact of respiratory dysfunction in elderly patients with cervical spinal cord injury and/or fractures: a multicenter survey.
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Hirota Ryosuke, Terashima Yoshinori, Ohnishi Hirofumi, Yamashita Toshihiko, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Suzuki Hidenori, Imajo Yasuaki, Ikegami Shota, Uehara Masashi, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Imagama Shiro, Kato Satoshi
Аннотация
METHODS: We included 1,353 elderly patients with SCI and/or fractures from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were included in the respiratory dysfunction group, which was further classified into mild and severe respiratory groups based on respiratory weaning management. Patient characteristics, laboratory data, neurological impairment scale scores, complications at injury, and surgical treatment were evaluated. We performed a propensity score-matched analysis to compare neurological outcomes and mobility between groups.
RESULTS: Overall, 104 patients (7.8%) had impaired respiratory function. In propensity score-matched analysis, the respiratory dysfunction group had a lower home discharge and ambulation rates (p = 0.018, p = 0.001, respectively), and higher rate of severe paralysis (p < 0.001) at discharge. At the final follow-up, the respiratory dysfunction group had a lower ambulation rate (p = 0.004) and higher rate of severe paralysis (p < 0.001). Twenty-six patients with severe disability required respiratory management for up to 6 months post-injury and died of respiratory complications. The mild and severe respiratory dysfunction groups had a high percentage of severe paraplegic cases with low ambulatory ability; there was no significant difference between them. The severe respiratory dysfunction group tended to have a poorer prognosis.
CONCLUSION: Respiratory dysfunction in elderly patients with SCI and/or cervical fracture in the early post-injury period reflects the severity of the condition and may be a useful prognostic predictor.