Cervical spine injury: factors associated with secondary pneumonia

Pneumonia is a life-threatening complication for cervical spine injured patients. We studied a retrospective cohort of 80 consecutive patients admitted between 1998 and 2002 in the Emergency Department. Mean age was 43 ± 16 years, sex ratio (female/male) 0.13. Mean SAPS II score was 22 ± 10. Patients with pneumonia were older (49 ± 16 years vs 41 ± 16 years, P < 0.05) and had a higher SAPS II score (26 ± 10 vs 18 ± 9, P < 0.01). The delay of admission in the critical care unit (CCU) was higher in the pneumonia group (0.3 ± 0.7 days vs 3.2 ± 4.0 days, P < 0.01). The delay of handling by a physiotherapist was also higher (3.7 ± 2.0 days vs 8.1 ± 8.0 days, P < 0.01). Pneumonia was associated with a longer period of mechanical ventilation (10 ± 11 days vs 21 ± 13 days, P < 0.05) and a longer stay in the CCU (8.6 ± 9.5 vs 39.2 ± 29.3, P < 0.0001). Univariate analysis of qualitative factors is presented in Table 1. Early mechanical ventilation, upper cervical spine involvment and inhospital mortality were not related to pneumonia. Overall mortality is higher in the pneumonia group.

Table 1

Our study suggests that an early and aggressive handling of patients with cervical spine injury, particularly with complete motor deficit, could be beneficial to decrease pneumonia incidence and its associated adverse events.