Early tracheostomy improves outcomes in severely injured children and adolescents

Holscher, Courtenay M.; Stewart, Camille L.; Peltz, Erik D.; Burlew, Clay Cothren; Moulton, Steven L.; Haenel, James B.; Bensard, Denis D.

doi:10.1016/j.jpedsurg.2013.09.002

Cited by 41 publications

(55 citation statements)

References 24 publications

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“…This may reflect a shift in practice towards the belief that earlier tracheostomy improves outcomes for critically ill patients, which has been wellestablished in adults(Gomes Silva et al, 2012) and has begun to gain acceptance in other pediatric populations, including trauma (Holscher et al, 2014) and burns (Palmieri, Jackson & Greenhalgh, 2002). However, even beyond this broader overall increase in tracheostomy, we found that children with CHD accounted for an increasing proportion of all tracheostomy admissions.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in children with congenital heart disease: a national analysis of the Kids' Inpatient Database.

Maxwell

McMillan

2014

Preprint

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Background: While single-institution studies reported the indications and outcomes of tracheostomy in children with congenital heart disease (CHD), no national analyses have been performed. We sought to examine the indications, performance, outcomes, and resource utilization of tracheostomy in children with CHD using a nationally representative database.Methods: We identified all children undergoing tracheostomy in the Kids' Inpatient Database 1997 through 2009, and we compared children with CHD to children without CHD. Within the CHD group, we compared children whose tracheostomy occurred in the same hospital admissions as a cardiac operation to those whose tracheostomy occurred without a cardiac operation in the same admission.Results: Tracheostomy was performed in n=2,495 children with CHD, which represents 9.6% of all tracheostomies performed in children (n=25,928), and 3.5% of all admissions for children with CHD (n=355,460). Over the study period, there was an increasing trend in the proportion of all tracheostomies that were done in children with CHD (p<0.0001) and an increasing trend in the proportion of admissions for children with CHD that involved a tracheostomy (p<0.0001). The population of children with CHD undergoing tracheostomy differed markedly in baseline characteristics, outcomes, and resource utilization. Similarly, the subgroup of children whose tracheostomy was performed in the same admission as a cardiac operation differed significantly from those whose tracheostomy was not.

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Section: Discussionmentioning

confidence: 99%

Tracheostomy in children with congenital heart disease: a national analysis of the Kids' Inpatient Database.

Maxwell

McMillan

2014

Preprint

View full text Add to dashboard Cite

show abstract

“…This may reflect a shift in practice towards the belief that earlier tracheostomy improves outcomes for critically ill patients, which has been well-established in adults (Gomes Silva et al, 2012) and has begun to gain acceptance in other pediatric populations, including trauma (Holscher et al, 2014) and burns (Palmieri, Jackson & Greenhalgh, 2002). However, even beyond this broader overall increase in tracheostomy, we found that children with CHD accounted for an increasing proportion of all tracheostomy admissions.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Maxwell

McMillan

2014

PeerJ

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Background. While single-institution studies reported the indications and outcomes of tracheostomy in children with congenital heart disease (CHD), no national analyses have been performed. We sought to examine the indications, performance, outcomes, and resource utilization of tracheostomy in children with CHD using a nationally representative database.Methods. We identified all children undergoing tracheostomy in the Kids’ Inpatient Database 1997 through 2009, and we compared children with CHD to children without CHD. Within the CHD group, we compared children whose tracheostomy occurred in the same hospital admission as a cardiac operation to those whose tracheostomy occurred without a cardiac operation in the same admission.Results. Tracheostomy was performed in n = 2,495 children with CHD, which represents 9.6% of all tracheostomies performed in children (n = 25,928), and 3.5% of all admissions for children with CHD (n = 355,460). Over the study period, there was an increasing trend in the proportion of all tracheostomies that were done in children with CHD (p < 0.0001) and an increasing trend in the proportion of admissions for children with CHD that involved a tracheostomy (p < 0.0001). The population of children with CHD undergoing tracheostomy differed markedly in baseline characteristics, outcomes, and resource utilization. Similarly, the subgroup of children whose tracheostomy was performed in the same admission as a cardiac operation differed significantly from those whose tracheostomy was not.Conclusions. Tracheostomy is an increasingly common procedure in children with CHD despite being associated with significantly greater resource utilization and in-hospital mortality. The population of children with CHD who undergo tracheostomy differs markedly from that of children without CHD who undergo tracheostomy, and important differences are observed between children who undergo tracheostomy in the same admission as a cardiac surgical procedure and those who undergo tracheostomy in a nonsurgical admission, as well as between children with single-ventricle physiology and children with two-ventricle physiology.

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“…Similar patient safety concerns exist in the paediatric population. Studies report overall mortality rates in paediatric patients with tracheostomies varying from 2.2% to 58.8%, whilst tracheostomy‐specific mortality is lower at 0.9% to 5.9% . Within our institution, concerns were noted regarding the risk of serious avoidable tracheostomy morbidity after merging three paediatric hospitals onto a single site in 2009.…”

Section: Introductionmentioning

confidence: 92%

Reduction in harm from tracheostomy‐related incidents after implementation of the paediatric National Tracheostomy Safety Project resources: A retrospective analysis from a tertiary paediatric centre

Doherty

Bowler

Monks

et al. 2017

Clinical Otolaryngology

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Early tracheostomy improves outcomes in severely injured children and adolescents

Cited by 41 publications

References 24 publications

Tracheostomy in children with congenital heart disease: a national analysis of the Kids' Inpatient Database.

Tracheostomy in children with congenital heart disease: a national analysis of the Kids' Inpatient Database.

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Reduction in harm from tracheostomy‐related incidents after implementation of the paediatric National Tracheostomy Safety Project resources: A retrospective analysis from a tertiary paediatric centre

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