Pediatric Trauma Society

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Early Tracheostomy for Pediatric Patients with Severe Traumatic Brain Injury Reduces Intensive Care Unit Stay and Ventilator Days
Brian Sheehan, MD1; Areg Grigorian, MD1; Catherine Kuza, MD2; Sahil Gambhir, MD1; Shelley Maithel, MD1; Matthew Dolich, MD1; Michael Lekawa, MD1; Jeffry Nahmias, MD1
1University of California, Irvine, Department of Surgery, Orange, CA; 2Keck School of Medicine, University of Southern California, Los Angeles, CA

Background: Evidence exists that early tracheostomy in adults with severe traumatic brain injury (TBI) reduces intensive care unit (ICU) length of stay (LOS) and ventilator days. Studies investigating this practice in the pediatric population are limited. We hypothesized that early tracheostomy in pediatric patients with severe TBI decreases ICU LOS and ventilator days.

Methods: The Pediatric Trauma Quality Improvement Program was queried for patients <16 years old with severe (≭ grade 4) TBI, who underwent tracheostomy from 2014-2016. Outcomes of early (day 1-6) versus late (day≭7) tracheostomy were compared using Student's t-test, and Chi-Square analysis.

Results: Sixteen patients underwent early, while 111 underwent late tracheostomy. The groups had similar distribution of age, gender, mechanism of injury, and mean injury severity scores (table 1, p>0.05). Early tracheostomy was associated with decreased ICU LOS (Early: 17 vs. Late: 32 days, p<0.05) and total ventilator days (Early: 9.7 vs. Late: 27.1 days, p<0.05). We found no difference in the incidence of acute respiratory distress syndrome (Early: 6.3% vs. Late: 2.7%, p=0.45), pneumonia (Early: 12.5% vs. Late: 29.7%, p=0.15), total LOS (Early: 26.7 vs. Late: 41.3 days, p=0.06), or mortality (Early: 0% vs. Late: 2%, p=0.588) between the two groups.

Conclusion: Similar to adults, early tracheostomy in pediatric patients with severe TBI is associated with decreased ICU LOS and ventilator days. Future prospective trials are needed to confirm our findings.

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