PREDICTORS OF HOSPITAL MORTALITY AND MECHANICAL VENTILATION IN PATIENTS WITH CERVICAL SPINAL-CORD INJURY

Purpose: The objective of this study was to identify predictors of dea th and mechanical ventilation in patients with traumatic cervical spin al cord injury. Methods: From 1981 to 1994, 72 patients with traumatic cervical spinal cord injury resulting in neurological deficits were i dentified in this retrospective study. For each patient, neurological and associated injuries, physiological variables, complications, hospi tal mortality and the need for mechanical ventilation were recorded. U nivariate and muiltivariate logistic regression analyses were done to identify predictors of mortality and the need for mechanical ventilati on. Results: Fifteen patients (21 %) died in The first three months af ter injury Univariate analyses identified age, heart disease, neurolog ical level at C-4 and above, GCS less than or equal to 13, forced vita l capacity and cough, to be associated with mortality. Multivariate lo gistic regression identified age (P = 0.01), neurological level (P = 0 .03) and GCS (P = 0.05) as independent predictors of mortality. In 41 patients (57%), the lungs were mechanically ventilated. Univariate ana lyses identified The following predictors of the need for mechanical v entilation: neurological level at C-5 and above, complete cord lesions , copious sputum, pneumonia and lung collapse. Multivariate logistic r egression identified copious sputum (P = 0.01) and pneumonia (P = 0.01 ) as independent predictors of the need for mechanical ventilation. Co nclusion: Age, neurological level and GCS are independent predictors o f mortality in patients with traumatic cervical spinal cord injury. Co pious sputum and pneumonia are independent predictors of the need for mechanical ventilation.