{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:29:36Z","timestamp":1771921776858,"version":"3.50.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tracheostomy is common in traumatic cervical spinal cord injury (TCSCI) because of respiratory complications, yet objective tools to estimate individual risk remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-center retrospective cohort at the Second Affiliated Hospital, Zhejiang University School of Medicine, we enrolled 308 consecutive ICU admissions with TCSCI (January 2018\u2013March 2023) and randomly split the cohort 7:3 (outcome-stratified) into training (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f215) and validation (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f93) sets. Candidate admission predictors were screened with Least Absolute Shrinkage and Selection Operator and then entered into multivariable logistic regression to construct a nomogram. Model performance included discrimination (AUC with bootstrap 95% CIs, 2,000 resamples), calibration (intercept, slope, Brier), and decision curve analysis (DCA). A prespecified clinical threshold of 0.30 was used to summarize sensitivity and specificity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five independent predictors were retained\u2014smoking history, thoracic injury, BMI\u202f\u2265\u202f25\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , cervical dislocation, and ASIA grade (A vs. B-D). The model showed strong discrimination (AUC 0.844, 95% CI 0.788\u20130.896 in training; 0.903, 95% CI 0.823\u20130.966 in validation) and good calibration. At the 0.30 threshold, performance was Sensitivity 0.781\/Specificity 0.725 (training) and Sensitivity 0.812\/Specificity 0.852 (validation); DCA demonstrated greater net benefit than \u201ctreat all\/none\u201d across threshold 0.10\u20130.70.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A parsimonious, five-factor nomogram based on routine admission data provides accurate, clinically interpretable stratification of tracheostomy risk in TCSCI. Clear reporting of ASIA coding and a prespecified decision threshold enhance bedside usability. Prospective, multi-center external validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2025.1684974","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:27:02Z","timestamp":1768458422000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a nomogram for predicting tracheostomy risk in traumatic cervical spinal cord injury"],"prefix":"10.3389","volume":"16","author":[{"given":"Weiting","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, The First People\u2019s Hospital of Linhai","place":["Taizhou, Zhejiang, China"]},{"name":"Department of Emergency and Intensive Care Unit, Linhai Branch of Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Taizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoshuang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The First People\u2019s Hospital of Linhai","place":["Taizhou, Zhejiang, China"]},{"name":"Department of Emergency and Intensive Care Unit, Linhai Branch of Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Taizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xixi","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care Unit, Linhai Branch of Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Taizhou, China"]},{"name":"Department of Traditional Chinese Medicine, The First People\u2019s Hospital of Linhai","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiuzhou","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The First People\u2019s Hospital of Linhai","place":["Taizhou, Zhejiang, China"]},{"name":"Department of Emergency and Intensive Care Unit, Linhai Branch of Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Taizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The First People\u2019s Hospital of Linhai","place":["Taizhou, Zhejiang, China"]},{"name":"Department of Emergency and Intensive Care Unit, Linhai Branch of Second Affiliated Hospital, Zhejiang University School of Medicine","place":["Taizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanlin","family":"Dou","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Lishui Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1038\/sc.2012.158","article-title":"The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate","volume":"52","author":"Lee","year":"2014","journal-title":"Spinal Cord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0323433","DOI":"10.1371\/journal.pone.0323433","article-title":"Neurological outcomes and predictive factors in traumatic spinal cord injury patients in the intensive care unit","volume":"20","author":"Yuan","year":"2025","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.13440","article-title":"Epidemiology of traumatic spinal 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