Andréane Richard-Denis1,2, Debbie Feldman3, Cynthia Thompson4, Martin Albert4,3, Jean-Marc Mac-Thiong4,3,5. 1. Research Center, Hopital du Sacré-Cœur de Montréal, Montréal, QC, Canada. andreane.rdenis@gmail.com. 2. Faculty of Medicine, University of Montreal, CP 6128, Succ Centre-ville, Pavillon 7077 Avenue du Parc, Montréal, Québec, Canada. andreane.rdenis@gmail.com. 3. Faculty of Medicine, University of Montreal, CP 6128, Succ Centre-ville, Pavillon 7077 Avenue du Parc, Montréal, Québec, Canada. 4. Research Center, Hopital du Sacré-Cœur de Montréal, Montréal, QC, Canada. 5. CHU Ste-Justine, Montreal, Canada.
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration. SETTING: A single Level-1 trauma center specialized in SCI care in Quebec (Canada). METHODS: A cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI-center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay. RESULTS: Patients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001). CONCLUSIONS: Early admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support. SPONSORSHIP: MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration. SETTING: A single Level-1 trauma center specialized in SCI care in Quebec (Canada). METHODS: A cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI-center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay. RESULTS:Patients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001). CONCLUSIONS: Early admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support. SPONSORSHIP: MENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.
Authors: Susan Charlifue; David Apple; Stephen P Burns; David Chen; Jeffrey P Cuthbert; William H Donovan; Daniel P Lammertse; Michelle A Meade; Christopher R Pretz Journal: Arch Phys Med Rehabil Date: 2011-03 Impact factor: 3.966
Authors: Lucy Z Kornblith; Matthew E Kutcher; Rachael A Callcut; Brittney J Redick; Charles K Hu; Thomas H Cogbill; Christopher C Baker; Mark L Shapiro; Clay C Burlew; Krista L Kaups; Marc A DeMoya; James M Haan; Christopher H Koontz; Samuel J Zolin; Stephanie D Gordy; David V Shatz; Doug B Paul; Mitchell J Cohen Journal: J Trauma Acute Care Surg Date: 2013-12 Impact factor: 3.313