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Early Tracheostomy and Outcomes in Ventilated Pediatric Trauma Patients

  • Nasim Ahmed
    Correspondence
    Corresponding author. and Reprints Contact: Nasim Ahmed, MD, FACS. Professor of Surgery. Hackensack Meridian School of Medicine.Chief of Trauma. Director of Surgical Critical Care. Department of Surgery. Division of Trauma & Surgical Critical CareJersey Shore University Medical Center. 1945 State Route 33. Neptune, NJ 07754. Tel.: +732 776-4949; fax: +732 776-4509.
    Affiliations
    Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune NJ USA

    Hackensack Meridian School of Medicine, Nutley, NJ
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  • Yen-Hong Kuo
    Affiliations
    Department of Research Administration, Jersey Shore University Medical Center, Neptune NJ USA

    Hackensack Meridian School of Medicine, Nutley, NJ
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      Summary

      Introduction

      The purpose of the study was to evaluate the outcomes of pediatric ventilated patients who underwent early tracheostomy. Our hypothesis is early tracheostomy will be associated with less ventilator days, Intensive care (ICU) days and hospital days.

      Methods

      The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through 2019 was used for the study. All pediatric trauma patients ≤17 years who were admitted to the hospital and were placed on mechanical ventilation were included in the study. Other variables included patients’ demography, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, types of procedure that were performed for hemorrhage control. Propensity score matching analysis was performed between the early (≤7 days) and late tracheostomy (>7 days) groups. The primary outcome of the study was total hospital length of stay. Other outcomes were ICU days, ventilator days.

      Results

      Propensity score matching created 643 pairs of patients. The median age (years [interquartile range]) of the patient was 14 [8-16]. Most patients suffered from severe injuries with a median ISS 29 [22-38] and GCS score was 3 [3-8]. There was no significant difference identified between the early and the late groups, in hospital stay (24 [23, 26] vs. 24 [23, 26], P=0.5), ICU days (14 [9-22] vs. 16 [9-23], P=0.073) and ventilator days (10 [6-17] vs. 11 [7-18], P=0.073). The incidence of pneumonia between the groups was (8.7% vs. 9.2%, P=0.347).

      Conclusion

      Early tracheostomy failed to show any outcomes benefit in ventilated pediatric trauma patients.
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