• Dawei Sun, Hanqing Zhao, and Zhengfeng Zhang.
• Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, 183 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
• Eur Spine J. 2022 May 1; 31 (5): 1283-1290.

ObjectiveTo develop a classification and regression tree (CART) model to predict the need of tracheostomy in patients with traumatic cervical spinal cord injury (TCSCI) and to quantify scores of risk factors to make individualized clinical assessments.MethodsThe clinical characteristics of patients with TCSCI admitted to our hospital from January 2014 to December 2020 were retrospectively analyzed. The demographic characteristics (gender, age, smoking history), mechanism of injury, injury characteristics (ASIA impairment grades, neurological level of impairment, injury severity score), preexisting lung disease and preexisting medical conditions were statistically analyzed. The risk factors of tracheostomy were analyzed by univariate logistic regression analysis (ULRA) and multiple logistic regression analysis (MLRA). The CART model was established to predict tracheostomy.ResultsThree hundred and forty patients with TCSCI met the inclusion criteria, in which 41 patients underwent the tracheostomy. ULRA and MLRA showed that age > 50, ISS > 16, NLI > C5 and AIS A were significantly associated with tracheostomy. The CART model showed that AIS A and NLI > C5 were at the first and second decision node, which had a significant influence on the decision of tracheostomy. The final scores for tracheostomy from CART algorithm, composed of age, ISS, NLI and AIS A with a sensitivity of 0.78 and a specificity of 0.96, could also predict tracheostomy.ConclusionThe establishment of CART model provided a certain clinical guidance for the prediction of tracheostomy in TCSCI. Quantifications of risk factors enable accurate prediction of individual patient risk of need for tracheostomy.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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