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Early clinical predictors of pneumonia in critically ill spinal cord injured individuals: a retrospective cohort study

Spinal Cord (2018) | Download Citation

Abstract

Study design

Retrospective cohort.

Objectives

Pneumonia is the dominant complication following traumatic spinal cord injury (SCI) and profoundly impacts morbidity by prolonging length of stay and worsening neurological outcome. The aims of this study were to determine the key predictors of clinically important pneumonia (CIP); and to examine the impact of CIP on resource utilisation in critically ill acute traumatic SCI individuals between 2010 and 2015.

Setting

Alfred and Austin Hospitals (Melbourne, Australia).

Methods

Data were extracted from the medical records of 93 cases of acute traumatic SCI resulting in ISNCSCI C3–L1 level of injury requiring admission to the intensive care unit and aged between 15 and 70 years. Patients with life-threatening injuries, not requiring spinal surgery, palliated within 7 days of injury, diagnosis of traumatic central cord syndrome or with poor general health, were excluded.

Results

A total of 33 episodes of CIP were observed. Median time to CIP diagnosis was 65 h (IQR: 42–93) and median time to spinal surgery was 22 h (IQR: 12–32). Four key predictors were identified; male gender (OR: 18.3, CI: 1.9–174.9, p = 0.001), motor complete injury (OR: 10.1, CI: 1.1–92.1, p = 0.011), presence of chest trauma (OR: 4.5, CI: 1.4–14.4, p = 0.007) and delayed intubation (HR: 6.8, CI: 1.6–28.6, p = 0.009).

Conclusions

This study identifies four key predictors involved in elevated pneumonia risk; male gender, motor complete injury, presence of chest trauma and delayed intubation, enabling the future synthesis of a pneumonia prediction tool for use in the acute postinjury period.

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Acknowledgements

Many thanks to Jim Sayer who assisted with data organisation and Sue Finch who assisted with statistical analysis.

Funding

This study is supported by the National Health and Medical Research Council; and by the Transport Accident Commission, through the Institute for Safety, Compensation and Recovery Research.

Author contributions

JA was responsible for the literature search, study design, data collection, data analysis, data interpretation, referencing, writing and critical revision. PEB was responsible for the study design, data analysis, data interpretation, writing and critical revision. CRB was responsible for the study design, writing and critical revision.

Author information

Affiliations

  1. Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Royal Parade, VIC, Australia

    • Jacqui Agostinello
    • , Camila R. Battistuzzo
    •  & Peter E. Batchelor

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Jacqui Agostinello.

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DOI

https://doi.org/10.1038/s41393-018-0196-6