Active Cough Sputum Clearance Grading System: A Novel Predictor of Early Tracheostomy in Patients With Acute Traumatic Cervical Spinal Cord Injury.

Abstract

Respiratory failure is the leading cause of death in patients with traumatic cervical spinal cord injury (TCSCI). Early tracheostomy can effectively reduce the risk of secondary respiratory failure in TCSCI patients. However, there is currently a lack of robust indicators to predict which patients will require early tracheostomy. Paralysis of respiratory muscles leads to weakened cough and impaired sputum clearance, which is a major cause of secondary respiratory failure. Whether cough and sputum clearance capacity can serve as a predictor for early tracheostomy remains unclear. To investigate the role of active cough and sputum clearance ability in predicting early tracheostomy, a retrospective cohort of 198 TCSCI patients was analyzed. Univariate and multivariate logistic regression analyses were conducted to determine whether the Active Cough Sputum Clearance Grading (ACSG) system serves as an independent predictive factor and to evaluate its effectiveness in predicting tracheostomy. Among 198 patients, 54 underwent tracheostomy, including 24 with ACSG grade 0, 30 with grade 1, and none with grades 2 or 3. Higher grades were associated with a lower likelihood of tracheostomy. In multivariate logistic regression, higher ACSG grade was independently associated with reduced odds of tracheostomy (OR 0.12; 95% CI 0.05-0.27; P < 0.001). The ACSG showed strong discriminative performance for predicting early tracheostomy (AUC 0.88; 95% CI 0.83-0.93). This study, for the first time, proposes a grading system for cough and sputum clearance in TCSCI, and our findings suggest that ACSG may have predictive value for early tracheostomy requirements.