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Review
. 2021 Dec 31;11(1):211.
doi: 10.3390/jcm11010211.

Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury

Anja Maria Raab  1   2 , Gabi Mueller  1 , Simone Elsig  3 , Simon C Gandevia  4   5 , Marcel Zwahlen  6 , Maria T E Hopman  7 , Roger Hilfiker  3
Affiliations
Review

Systematic Review of Incidence Studies of Pneumonia in Persons with Spinal Cord Injury

Anja Maria Raab et al. J Clin Med. .

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.

Keywords: incidence; pneumonia; spinal cord injury; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram. Systematic review of incidence studies of pneumonia in persons with spinal cord injury.
Figure 2
Figure 2
Forest Plot of all included study samples, without pooled results. CI = confidence interval; Fup, Follow up; G-Csf, granulocyte colonystimulating factor; ICU, Intensive Care Unit; LT-Ventilated, long-term ventilated; MPSS, high-dose methylprednisolone sodium succinate; n.m., not mentioned; Para, paraplegia; Rehab, rehabilitation; Tetra, tetraplegia; Ventilation, mechanical ventilation.
See this image and copyright information in PMC

References

    1. Marsolais E.B., Boninger M.L., McCormick P.C., Love L., Mackelprang R.W., Dalsey W.C. Respiratory management following spinal cord injury: A clinical practice guideline for health-care professionals. J. Spinal Cord Med. 2005;28:259–293. - PubMed
    1. Wang A.Y., Jaeger R.J., Yarkony G.M., Turba R.M. Cough in spinal cord injured patients: The relationship between motor level and peak expiratory flow. Spinal Cord. 1997;35:299–302. doi: 10.1038/sj.sc.3100370. - DOI - PubMed
    1. Lanig I.S., Peterson W.P. The respiratory system in spinal cord injury. Phys. Med. Rehabil. Clin. N. Am. 2000;11:29–43. doi: 10.1016/S1047-9651(18)30145-1. - DOI - PubMed
    1. Savic G., DeVivo M.J., Frankel H.L., Jamous M.A., Soni B.M., Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017;55:891–897. doi: 10.1038/sc.2017.64. - DOI - PubMed
    1. Jackson A.B., Groomes T.E. Incidence of respiratory complications following spinal cord injury. Arch. Phys. Med. Rehabil. 1994;75:270–275. doi: 10.1016/0003-9993(94)90027-2. - DOI - PubMed