Tracheostomy risk factors and outcomes after severe traumatic brain injury

Humble, Stephen S.; Wilson, Linda; McKenna, John; Leath, Taylor C.; Song, Yanna; Davidson, Mario; Ehrenfeld, Jesse M.; Guillamondegui, Oscar D.; Pandharipande, Pratik P.; Patel, Mayur B.

doi:10.1080/02699052.2016.1199915

Cited by 22 publications

(13 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Humble et al studied risk factors associated with tracheostomy placement in patients who suffered traumatic brain injury. 25 Notably, the study found that patients with private insurance were more likely to receive a tracheostomy than uninsured patients; however, there was no association with mortality. That study was limited in that insurance coverage does not encompass the many elements of socioeconomic status such as education level, income, and social support.…”

Section: Discussionmentioning

confidence: 89%

“…The impact of socioeconomic status on mortality has not been extensively studied in tracheostomy patients. Humble et al studied risk factors associated with tracheostomy placement in patients who suffered traumatic brain injury . Notably, the study found that patients with private insurance were more likely to receive a tracheostomy than uninsured patients; however, there was no association with mortality.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of patient factors associated with 30‐day mortality after tracheostomy

et al. 2018

View full text Add to dashboard Cite

Objective Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30‐day survival posttracheostomy. Methods This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30‐day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities. Results Of 326 tracheostomies identified, the 30‐day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30‐day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30‐day survival. Conclusion Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30‐day mortality posttracheostomy. No association was found between BMI or SES and 30‐day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy. Level of Evidence 3 Laryngoscope, 129:847–851, 2019

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Analysis of patient factors associated with 30‐day mortality after tracheostomy

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Here we found that tracheotomy was an independent factor for unfavorable outcome. Some studies have shown increased survival in patients with tracheostomy compared with patients who remained intubated after severe TBI 40 , 41 . However, the optimal time to perform tracheostomy remains a highly controversial topic.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma

Liu¹,

Xie²,

Xiao³

et al. 2021

Int. J. Med. Sci.

View full text Add to dashboard Cite

Objective: The purpose of this study was to investigate whether routine blood tests on admission and clinical characteristics can predict prognosis in patients with traumatic brain injury (TBI) combined with extracranial trauma. Methods: Clinical data of 182 patients with TBI combined with extracranial trauma from April 2018 to December 2019 were retrospectively collected and analyzed. Based on GOSE score one month after discharge, the patients were divided into a favorable group (GOSE 1-4) and unfavorable group (GOSE 5-8). Routine blood tests on admission and clinical characteristics were recorded. Results: Overall, there were 48 (26.4%) patients with unfavorable outcome and 134 (73.6%) patients with favorable outcome. Based on multivariate analysis, independent risk factors associated with unfavorable outcome were age (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.018-1.124; p< 0.01), admission Glasgow Coma Scale (GCS) score (OR, 0.807; 95% CI, 0.675-0.965; p< 0.05), heart rate (OR, 1.035; 95% CI, 1.004-1.067; p< 0.05), platelets count (OR, 0.982; 95% CI, 0.967-0.997; p< 0.05), and tracheotomy (OR, 15.201; 95% CI, 4.121-56.078; p< 0.001). Areas under the curve (AUC) of age, admission GCS, heart rate, tracheotomy, and platelets count were 0.678 (95% CI, 0.584-0.771), 0.799 (95% CI, 0.723-0.875), 0.652 (95% CI, 0.553-0.751), 0.776 (95% CI, 0.692-0.859), and 0.688 (95% CI, 0.606-0.770), respectively. Conclusions: Age, admission GCS score, heart rate, tracheotomy, and platelets count can be recognized as independent predictors of clinical prognosis in patients with severe TBI combined with extracranial trauma.

show abstract

“…Data on mortality after early tracheostomy are mixed. Humble et al 12 concluded in 2016 that patients with early tracheostomy placement had an increased survival after severe TBI. Meanwhile, Young et al 13 concluded that there was no difference in 30-day mortality in ICU patients who received early (<4 days) tracheostomy versus late tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Early versus Late Tracheostomy: Is There an Outcome Difference?

Elkbuli

Narvel

Spano

et al. 2019

The American Surgeon

View full text Add to dashboard Cite

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

show abstract

Tracheostomy risk factors and outcomes after severe traumatic brain injury

Cited by 22 publications

References 38 publications

Analysis of patient factors associated with 30‐day mortality after tracheostomy

Analysis of patient factors associated with 30‐day mortality after tracheostomy

Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma

Early versus Late Tracheostomy: Is There an Outcome Difference?

Contact Info

Product

Resources

About