American journal of surgery · 2026
High utilization of early tracheostomy is associated with shortened ICU length-of-stay but not improved outcomes in pediatric TBI: A TQIP analysis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Tang-Tan Angela, Bent Christine Isabella, Nekooei Negar, Lin Michelle, Daggupati Sindhu, Wong Monica, Siletz Anaar E, Matsushima Kazuhide, Inaba Kenji, Poblete Roy A, Martin Matthew J
Аннотация
BACKGROUND: Optimal tracheostomy timing in pediatric traumatic brain injury (TBI) remains uncertain. We evaluated whether center-level early tracheostomy (≤7 days) practices are associated with clinical outcomes.
METHODS: The Trauma Quality Improvement Program (2017-2021) was queried for patients <18 years with severe TBI (Head AIS >3) who underwent tracheostomy. Centers in the highest tertile of early tracheostomy use were classified as early centers. Multivariate regression compared mortality, hospital and ICU length of stay (LOS), and respiratory complications.
RESULTS: Among 975 patients, 357 (37%) were treated at early centers and 618 (63%) at late centers. Injury severity was similar between groups. Early centers had shorter ICU LOS (-2.6 days; 95% CI, 0.65-4.56; p = 0.009) but higher in-hospital mortality (aOR 2.27; 95% CI, 1.19-4.35; p = 0.013). Hospital LOS and respiratory complications did not differ.
CONCLUSIONS: Greater center-level early tracheostomy utilization was associated with shorter ICU stay but no overall clinical benefit and higher mortality.
METHODS: The Trauma Quality Improvement Program (2017-2021) was queried for patients <18 years with severe TBI (Head AIS >3) who underwent tracheostomy. Centers in the highest tertile of early tracheostomy use were classified as early centers. Multivariate regression compared mortality, hospital and ICU length of stay (LOS), and respiratory complications.
RESULTS: Among 975 patients, 357 (37%) were treated at early centers and 618 (63%) at late centers. Injury severity was similar between groups. Early centers had shorter ICU LOS (-2.6 days; 95% CI, 0.65-4.56; p = 0.009) but higher in-hospital mortality (aOR 2.27; 95% CI, 1.19-4.35; p = 0.013). Hospital LOS and respiratory complications did not differ.
CONCLUSIONS: Greater center-level early tracheostomy utilization was associated with shorter ICU stay but no overall clinical benefit and higher mortality.