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. Notably, advancements in therapies have contributed to increased survival rates among SCI patients. This evolving landscape emphasises the need to shift healthcare priorities towards 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 aim to investigate the effect of spinal cord injury in mechanical ventilations at discharge using the National Spinal Cord Injury Model System Database (NSCIMS).

Methods: We conducted a search within the NSCIMS database to obtain a representative subset of individuals diagnosed with SCI in the United States. Our sample comprised 3,339 patients registered in the database. We specifically enrolled participants aged 18 years and above, who exhibited cervical spinal cord injuries and had documented outcome information available. The primary outcome is assessing the necessity for MV post-injury and during the hospitalisation phase.

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 optimising outcomes for this vulnerable patient population.