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Objectives  To explore the difference between tracheostomy and non‐tracheostomy and identify the risk factors associated with the need for tracheostomy after traumatic cervical spinal cord injury (TCSCI).    Methods  The demographic and injury characteristics of 456 TCSCI patients, treated in the Xinqiao Hospital from 2010 to 2019, were retrospective analyzed. Patients were divided into the tracheostomy group ( n  = 63) and the non‐tracheostomy group ( n  = 393). Variables included were age, gender,smoking history, mechanism of injury, concomitant injury, American Spinal Injury Association (ASIA) Impairment Scale, the neurological level of injury, Cervical Spine Injury Severity Score (CSISS), surgery, and length of stay in ICU and hospital. SPSS 25.0 (SPSS, Chicago, IL) was used for statistical analysis and ROC curve drawing. Chi‐square analysis was applied to find out the difference of variables between the tracheostomy and non‐tracheostomy groups. Univariate logistic regression analysis (ULRA) and multiple logistic regression analysis (MLRA) were used to identify risk factors for tracheostomy. The area under the ROC curve (AUC) was used to evaluate the performance of these risk factors.    Results  Of 456 patients who met the inclusion criteria, 63 (13.8%) underwent tracheostomy. There were differences in age (χ 2  = 6.615,  P  = 0.032), mechanism of injury (χ 2  = 9.87,  P  = 0.036), concomitant injury (χ 2  = 6.131,  P  = 0.013),ASIA Impairment Scale (χ 2  = 123.08,  P  < 0.01), the neurological level of injury (χ 2  = 34.74,  P  < 0.01), and CSISS (χ 2  = 19.612,  P  < 0.01) between the tracheostomy and non‐tracheostomy groups. Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as potential risk factors for tracheostomy by ULRA. Smoking history ( OR  = 2.960, 95%  CI : 1.524–5.750,  P  = 0.001), CSISS ≥ 7 ( OR  = 4.599, 95%  CI : 2.328–9.085,  P  = 0.000), AIS A ( OR  = 14.213, 95%  CI : 6.720–30.060,  P  = 0.000) and NLI ≥ C5 ( OR  = 8.312, 95%  CI : 1.935–35.711,  P  = 0.004) as risk factors for tracheostomy were determined by MLRA. The AUC for the risk factors of tracheostomy after TCSCI was 0.858 (95%  CI : 0.810–0.907).    Conclusions  Smoking history, CSISS ≥ 7, AIS A and, NLI ≥ C5 were identified as risk factors needing of tracheostomy in patients with TCSCI. These risk factors may be important to assist the clinical decision of tracheostomy.

Risk Factors for Tracheostomy after Traumatic Cervical Spinal Cord Injury: A 10‐Year Study of 456 Patients