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Title: Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study.
Austin Authors: Mueller, Gabi;Berlowitz, David J ;Raab, Anja M;Postma, Karin;Gobets, David;Huber, Burkhart;Hund-Georgiadis, Margret;Jordan, Xavier;Schubert, Martin;Wildburger, Renate;Brinkhof, Martin W G
Affiliation: Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Institute for Breathing and Sleep
School of Health Professions of Bern University of Applied Sciences, Switzerland.
Rijndam Rehabilitation, Rotterdam, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands.
Rehabilitation Center, Häring, Austria.
REHAB Basel, Basel, Switzerland.
Clinique Romande de Réadaptation, Sion, Switzerland.
Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.
Rehabilitation Clinic Tobelbad, Austria.
Swiss Paraplegic Research, Nottwil, Switzerland; Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
University of Melbourne, Austin Health, Melbourne, Australia.
Issue Date: 30-Nov-2023
Date: 2023
Publication information: Archives of Physical Medicine and Rehabilitation 2023-11-30
Abstract: To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Multi-centric, longitudinal cohort study. 10 specialized SCI rehabilitation units in Europe and Australia. Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). Not applicable. We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH2O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia.
DOI: 10.1016/j.apmr.2023.11.002
Journal: Archives of Physical Medicine and Rehabilitation
PubMed URL: 38032554
ISSN: 1532-821X
Type: Journal Article
Subjects: Maximal respiratory pressures
Pulmonary infection
Appears in Collections:Journal articles

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