Predictive Model For Early Tracheostomy Requirement In Pediatric Trauma Patients With Head Injury - A National Trauma Databank Study
Radu Filipescu1, Colin Powers1, Han Yu2, David Rothstein1, Carroll Harmon1, Weidun Guo3, Kathryn Bass1
1Oishei Children's Hospital, Buffalo, NY;2Rosswel Oncologic Institute, Buffalo, NY;3Department of Surgery, SUNY, Jacobs School of Medicine, Buffalo, NY
Purpose ‒ Early tracheostomy (ETT ≤ 7 days post-admission) in head injured (HI) patients decreases the time on ventilator (TOV) and length of stay in the ICU (ICU-LOS). We sought to identify predictors for ventilator dependence and develop a predictive model for early TT in pediatric trauma patients.
Methods ‒ We performed a retrospective database analysis (NTDB 2011-2015) of pediatric patients (aged 0-18) with ICD-9 codes associated with HI referencing duration of loss of consciousness (LOC: none, <1hr, <24hrs, >24hrs with or without return to baseline). Early and late TT (LTT) groups were compared in terms of age, ISS, admission GCS, time to TT placement (TTP), TOV, ICU-LOS and duration of LOC. Multivariate analysis was used to identify predictors for ventilator dependence at 14 days post-admission.
Results ‒ The incidence of TT placement was 4.4% (N=494 among a total of 11.003 patients). Among them, 23.6% of TT were early. Patients with early TT had shorter TOV (12.54 ± 7.8 vs 20.9 ± 12.6, P < 0.001) and shorter ICU-LOS (15.6 ± 7.42 vs 25.87 ± 12.8, P < 0.001). There were no differences between ETT and LTT groups in terms of ISS, GCS and mean duration of LOC. ISS≥25, GCS<8 and LOC>24hrs predicted ventilator dependence at 14 days post-admission with 88% sensitivity and specificity (AUROC=0.940, 95% CI [0.934, 0.947], P<0.001).
Conclusions ‒ Early TT shortens TOV and ICU-LOS and should be considered in patients at risk for ventilator dependence. The duration of LOC after HI in pediatric trauma patients accurately predicts ventilator dependence at 14 days.
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