Ventilation Requirements in Patients with Spinal Cord Injury at the Level of C3 to C5: a Retrospective NSCIMS Database Study.

Introduction: The prevalence of spinal cord injury (SCI) in the U.S. has impacted around 500,000 people. Advancements in therapies have contributed to increased survival rates among SCI patients. This evolving landscape emphasizes the need to shift healthcare priorities toward enhancing the well-being of those affected. Among these injuries, high cervical SCI stands out due to its significant impact, causing severe disabilities, increased mortality, and substantial socioeconomic challenges due to mechanical ventilation (MV). We aimed to investigate the effect of spinal cord injury in mechanical ventilation at discharge using the National Spinal Cord Injury Model System Database (NSCIMS).

Methods: A search was conducted within the NSCIMS database to identify a subset representing the SCI-affected individuals in the U.S. The study included 3,339 patients, focusing on participants aged 18 and above with documented cervical spinal cord injuries and available outcome data. The primary aim is to evaluate the necessity of MV post-injury and during hospitalization. Both univariate and multivariate analyses were utilized to delve into the MV's relationship with different cervical levels.

Results: A cohort of 1507 patients that met inclusion criteria was examined. The mean age within this cohort was 43.3 (±17.7) years, with 332 individuals (22.0%) being female. The majority identified as White (72.8%), and the most common civil statuses were never married (41.1%) and married (39.0%) at the time of injury. The most prevalent causal factors for cervical SCI were vehicular incidents (44.3%) and falls (34.8%). Smoking was reported in 94 patients (17.7%). Upon admission, 226 patients (15.0%) necessitated mechanical ventilation (MV). Comparatively, a higher proportion of the MV group displayed injuries at or above the C3 level, including C3 and C4, in contrast to those without MV (p-value < 0.001). Furthermore, patients in the MV group exhibited inferior ASIA scores, a higher incidence of complete tetraplegia, and longer hospital stays (p-value < 0.001) compared to those not requiring MV.

Conclusion : These findings show the association between high cervical SCI, the necessity for mechanical ventilation, and the associated clinical implications. Such insights can significantly inform both clinical practice and healthcare policies, driving interventions aimed at optimizing outcomes for this vulnerable patient population.