Abstract
Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia.
Highlights
Pneumonia continues to complicate the course of spinal cord injury (SCI)
This systematic review and meta-regression of 24 studies analyzed the incidence of pneumonia in SCI
Given that most pneumonia occurs early after the SCI (Figure 2), we propose the need for a greater focus on regular screening of pulmonary and respiratory muscle function in the ICU and implementation of potential strategies to enhance pulmonary and respiratory muscle function
Summary
Pneumonia continues to complicate the course of spinal cord injury (SCI). Clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. Respiratory complications are one of the main comorbidities after SCI, especially among persons with cervical and high thoracic injury [1]. The underlying problem is paralysis of the respiratory muscles, which leads to poor mobilization of secretion, bacterial accumulation in the secretion, and resultant respiratory infections [1,2,3]. The higher the level of SCI, the greater is the risk of respiratory complications [2]. About 30% of all deaths after an SCI are due to respiratory causes, with pneumonia as the most common respiratory cause [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
