Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study

Mueller, Gabi; Berlowitz, David; Raab, Anja; Postma, Karin; Gobets, David; Huber, Burkhart; Hund-Georgiadis, Margret; Jordan, Xavier; Schubert, Marti; Wildburger, Renate; Brinkhof, Martin (2023). Incidence and Risk Factors of Pneumonia in Individuals With Acute Spinal Cord Injury: A Multi-national, Multi-center, Prospective Cohort Study (In Press). Archives of Physical Medicine and Rehabilitation Elsevier 10.1016/j.apmr.2023.11.002

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Objective: To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Design: Multi-centric, longitudinal cohort study. Setting: 10 specialized SCI rehabilitation units in Europe and Australia. Participants: 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). Interventions: Not applicable. Main Outcome Measures: 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. Results: 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 cmH 2O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97).

Item Type:	Journal Article (Original Article)
Division/Institute:	School of Health Professions School of Health Professions > Academic-Practice-Partnership Insel Gruppe/BFH
Name:	Mueller, Gabi; Berlowitz, David; Raab, Anja0000-0002-4139-2173; Postma, Karin; Gobets, David; Huber, Burkhart; Hund-Georgiadis, Margret; Jordan, Xavier; Schubert, Marti; Wildburger, Renate and Brinkhof, Martin
Subjects:	R Medicine > RZ Other systems of medicine
ISSN:	00039993
Publisher:	Elsevier
Funders:	[UNSPECIFIED] Wings for Life Austria
Language:	English
Submitter:	Anja Raab
Date Deposited:	08 Dec 2023 10:09
Last Modified:	08 Dec 2023 10:09
Publisher DOI:	10.1016/j.apmr.2023.11.002
Uncontrolled Keywords:	Spinal Cord Injury, Respiratory complications, pneumonia
ARBOR DOI:	10.24451/arbor.20580
URI:	https://arbor.bfh.ch/id/eprint/20580