Influencing factors of tracheotomy after cervical spinal cord injury: a Meta-analysis

English Keywords:Cervical spinal cord injury  Tracheotomy  Influencing factors  Meta-analysis

English Abstract:

  【Abstract】 Objetives: To systematically assess the influencing factors of tracheotomy after cervical spinal cord injury, and to provide evidence-based information for developing measures of respiratory management in patients with cervical spinal cord injury. Methods: PubMed, Embase, Medline, Cochrane Library, Chinese Biological Medical Literature database(CBM), China National Knowledge Infrastructure database(CNKI) and Wanfang database were searched for relevant published literature studying the influencing factors of tracheotomy after cervical spinal cord injury. Meta analysis was performed by using Rev Man 5.3 software, and the data were pooled by using a fixed effect model or a random effect model to calculate the odds ratio(OR)/mean difference(MD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: Sixteen studies containing 9697 patients with cervical spinal cord injury met the inclusion criteria. The rate of tracheotomy was 18.3%. Meta-analysis showed that there were significant differences in male [OR=1.29, 95%CI(1.12, 1.49), P=0.0004], ASIA A[OR=7.79, 95%CI(5.28, 11.50), P<0.00001], ASIA B[OR=1.15, 95%CI(1.13, 2.02), P=0.005], ASIA C[OR=0.28, 95%CI(0.20, 0.41), P<0.00001], ASIA D[OR=0.04, 95%CI(0.02, 0.09), P<0.00001], the neurological level of injury(NLI)[OR=2.36, 95%CI(1.51, 3.68), P=0.0002], injury severity score(ISS)[MD=8.97, 95%CI(8.11, 9.82), P<0.00001], Glasgow Coma Scale(GCS)≤8[OR=6.03, 95%CI(2.19, 16.61), P=0.0005], thoracic injury[OR=1.78, 95%CI(1.55, 2.04), P<0.00001] and respiratory complications[OR=5.97, 95%CI(4.03, 8.86), P<0.00001] and tracheostomy in patients with cervical spinal cord injury. while there was no significant correlation between the patient′s age, advanced age, brain injury, smoking history, traffic accident injury and fall injury and tracheostomy(P>0.05). Conclusions: The current evidence shows that male, AIS A, AIS B, the neurological level of injury(upper cervical spinal cord injury), ISS, GCS≤8, thoracic injury, respiratory complication are risk factors for tracheotomy after cervical spinal cord injury. AIS C and AIS D are the protective factors.