• Andréane Richard-Denis, Debbie Feldman, Cynthia Thompson, Martin Albert, and Jean-Marc Mac-Thiong.
• Research Center, Hopital du Sacré-Cœur de Montréal, Montréal, QC, Canada. andreane.rdenis@gmail.com.
• Spinal Cord. 2018 Feb 1; 56 (2): 142-150.

Study DesignRetrospective cohort study.ObjectivesTo compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration.SettingA single Level-1 trauma center specialized in SCI care in Quebec (Canada).MethodsA cohort of 81 individuals with complete tetraplegia over a 6-years period was included. Group 1 (N = 57- early group-) was admitted before surgical management in one specialized acute SCI-center, whereas Group 2 (N = 24 -late group-) was surgically managed in a non-specialized center and transferred to the SCI-center for post-operative management only. The proportion of tracheostomy placement and MV duration were compared. Multivariate regression analysis was used to assess the impact of the timing of admission to the SCI-center on the MV duration during the SCI-center stay.ResultsPatients in Group 2 had a higher proportion of tracheostomy (70.8 vs. 35.1%, p = 0.004) and a higher mean duration of MV support (68.0 ± 64.2 days vs. 21.8 ± 29.7 days, p = 0.006) despite similar age, trauma severity (ISS), neurological level of injury and proportion of pneumonia. Later transfer to the specialized acute SCI-center was the main predictive factor of longer MV duration, with a strong impact factor (s = 946.7, p < 0.001).ConclusionsEarly admission to a specialized acute SCI-center for surgical and peri-operative management after a complete tetraplegia is associated with lower occurrence of tracheostomy and shorter mechanical ventilation duration support.SponsorshipMENTOR Program of the Canadian Institute of Health Research and US Department of Defense Spinal Cord Injury Research Program.

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