Objective/Hypothesis: To study the outcomes and complications associated with pediatric tracheotomy, as well as the changing trend in indications and out· comes since 1970. Study Design: Retrospective chart review at a major tertiary care children's hospital.
Methods:On childr~n who underwent tracheotomy at Children's Hospital of the King's Daughters (Norfolk, VA) between 1988 and 1998, inpatient and outpatient records were reviewed. Of 218 tracheotomies, sufficient data were available on 204. Indications for tracheotomy were placed into the following six groups: craniofacial abnormalities (13%), upper airway ob· struction (19o/ o), prolonged intubation (26%), neuro· logical impairment (27%), trauma (7%), and vocal fold paralysis (7%). Results: The average age at tracheotomy was 3.2 ± 0.6 years. Although the prolonged in· tubation group was significantly younger than all others, the neurological impairment and trauma groups were significantly older. Decannulation was accomplished in 41 %. Time to decannulation was significantly higher in the neurological impairment and prolonged intubation groups, but was significantly shorter in the craniofacial group. Complications occurred in 44%. Overall mortality was 19o/ o, with a 3.6% tracheotomy-related death rate. Comparison of our series to other published series of pediatric tracheotomies since 1970 shows fewer being performed for airway infections and more for chronic diseases, with a corresponding increase in duration of tracheotomy and decreased decannulation rates. Conclusions: Tracheotomy is a procedure performed with relative frequency at tertiary care children's hospitals. While children receiving a tracheotomy have a high overall mortality, deaths are usually related to the underlying disease, not the tracheotomy itself.
Pediatric tracheotomy is associated with significant variation in rates and outcomes across the United States and across different hospital types. Further research to clarify the reasons for these associations is warranted.
Our current UNHS protocol using sequential ABR has been successful in screening virtually all neonates and providing timely intervention. This retrospective review has shown one HL diagnosis for every 811 babies screened without high-risk factors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.