The Dose-Response Relationship Between Age and Tracheostomy in Patients with Traumatic Cervical Spinal Cord Injury: A Restricted Cubic Spline Function Analysis.

Abstract

To investigate the continuous relationship between age and tracheostomy in patients with traumatic cervical spinal cord injury (TCSCI). This study comprised 689 TCSCI patients in total. The logistic regression and restricted cubic spline analysis was applied to analyze the possible dose-response relationship between age and tracheostomy. The subgroup analysis was performed for the American Spinal Injury Association (ASIA) grade and neurological level of injury. The proportion of patients with the age ≥60 was significantly higher in the tracheostomy group than in the non-tracheostomy group (42.2% vs. 19.6%; P < 0.001). Age ≥60 was independently associated with tracheostomy (total: odds ratio = 3.560, 95% confidence interval: 1.892-6.697; P < 0.001) after adjusting for gender, smoking history, dislocation, respiratory complications, ASIA grade, neurological level of injury, preexisting lung disease, brain injury, and thoracic injury. After the relationship was presented in the subgroup analysis, the restricted cubic spline revealed a nonlinear relationship between age and tracheostomy (P-overall < 0.001 and P-nonlinear = 0.021). Age and tracheostomy present a dose-response relationship in patients with TCSCI. This finding could help physicians bring assistance in the early identification of tracheostomy and rationalize the allocation of medical resources.