Incidence and predictors of lower respiratory tract infections among patients with traumatic spinal cord injuries at Mulago Hospital

Abstract

Background: Respiratory tract infection is a common complication following traumatic spinal cord injury (TSCI), this largely increases morbidity, prolonged length of hospital stay and worsening neurological outcome as it causes delay in surgical intervention and patient rehabilitation. The prevalence of RTI was reported to be 11.4% in Nigeria and up to 68% in USA. The commonest predictor of respiratory tract infection is high levels of spinal cord injury (>T8) which leads to loss of cough reflex. The incidence and the predictors of LRTI in patients with TSCI are not well documented in our setting. General objective: To determine the incidence and the predictors of LRTI in patients with TSCI admitted to spine and trauma wards at Mulago Hospital. Methods: This was a prospective cohort study conducted at Mulago hospital spine and trauma ward for a period of six months among 73 patients with TSCI. Data was collected consecutively using an interviewer administered semi-structured questionnaire, data was entered in Epidata version 4.2 and analyzed using STATA 15.1 at both bivariate and multivariate levels using Cox proportionate hazard model and presented as hazard ratios with their 95% confidence intervals. A P-value of 0.05 was considered to be significant at multivariate analysis. Results: A total of 73 participants were recruited for the study, the mean and standard deviation of their age was 33±13 years old of which 87.7% (n=64) were males. The incidence of LRTI was 32.9% [95%CI: 22.3-44.9] or 24 infections per 1000 patients per day. The predictors of LRTI were; being single HR = 0.29 [0.12-0.70] P= 0.006, history of smoking a HR =4.86 [1.73-13.67] P=0.003, having spine surgery done a HR = 3.73 [1.47-9.43] P=0.005, ASIA class C a HR =0.14 [0.03-0.65] P= 0.012. Conclusions and recommendations: The incidence of LRTI in patients with TSCI in Mulago Hospital was high at 32.9%. The predictors were, smoking (p=o.oo3), spine surgery (0.005), ASIA class C (p=0.012) and being single (p=0.006). I recommend: Surgical intervention, provision of functional nursing beds, SOPs for chest physiotherapy. Close attention to be given to spine injured patients who are single, have ASIA class A & B and/or History of smoking as they have a high risk of developing LRTI. There is need for formulation of standard operating procedures for appropriate management of SCI patients in order to prevent early development of respiratory complications. The risk of smoking needs to be stressed via public health education and punitive implementation and actions. Further research onto the bacteriology and outcome of LRTI in patients with TSCI needs to be done.