High utilization of early tracheostomy is associated with shortened ICU length-of-stay but not improved outcomes in pediatric TBI: A TQIP analysis.

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.