Complete cervical spinal cord injury above C6 predicts the need for tracheostomy

Am J Surg. 2014 May;207(5):664-8; discussion 668-9. doi: 10.1016/j.amjsurg.2014.01.001. Epub 2014 Feb 1.


Background: Failed extubation and delayed tracheostomy contribute to poor outcomes in patients with a traumatic spinal cord injury (SCI). We determined if the level and completeness of SCI predict the need for tracheostomy.

Methods: Data from 256 patients with SCI between C1 and T3 with or without tracheostomy were retrospectively analyzed. Logistic regression identified predictors for tracheostomy. Data are presented as raw percentage or odds ratio (OR) with 95% confidence interval. P < .05 indicates significance.

Results: Complete spinal cord injuries were common in patients requiring tracheostomy (55% vs 18%, P < .05), and predicted the need for tracheostomy (OR: 6.4 (3.1 to 13.5), P < .05). An injury above C6 predicted the need for tracheostomy in patients with complete injury (OR: 3.7 (1 to 11.9), P < .05), but not incomplete injury (OR: .7 (.3 to 1.9); P = .53).

Conclusion: Tracheostomy is unlikely in patients with incomplete SCI, regardless of the level of injury. Patients with complete SCI above C6 are likely to require tracheostomy.

Keywords: Cervical spinal cord; Complete injury; Tracheostomy.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Cervical Vertebrae / injuries
  • Decision Support Techniques*
  • Female
  • Glasgow Coma Scale
  • Humans
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Spinal Cord Injuries / surgery*
  • Tracheostomy*