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. 2023 Apr 1;94(4):615-623.
doi: 10.1097/TA.0000000000003848. Epub 2022 Nov 28.

Variation in tracheostomy placement and outcomes following pediatric trauma among adult, pediatric, and combined trauma centers

Elizabeth Y Killien  1 , Kalee L Grassia, Elissa K Butler, Stephen J Mooney, R Scott Watson, Monica S Vavilala, Frederick P Rivara
Affiliations

Variation in tracheostomy placement and outcomes following pediatric trauma among adult, pediatric, and combined trauma centers

Elizabeth Y Killien et al. J Trauma Acute Care Surg. .

Abstract

Background: Tracheostomy placement is much more common in adults than children following severe trauma. We evaluated whether tracheostomy rates and outcomes differ for pediatric patients treated at trauma centers that primarily care for children versus adults.

Methods: We conducted a retrospective cohort study of patients younger than 18 years in the National Trauma Data Bank from 2007 to 2016 treated at a Level I/II pediatric, adult, or combined adult/pediatric trauma center, ventilated >24 hours, and who survived to discharge. We used multivariable logistic regression adjusted for age, insurance, injury mechanism and body region, and Injury Severity Score to estimate the association between the three trauma center types and tracheostomy. We used augmented inverse probability weighting to model the likelihood of tracheostomy based on the propensity for treatment at a pediatric, adult, or combined trauma center, and estimated associations between trauma center type with length of stay and postdischarge care.

Results: Among 33,602 children, tracheostomies were performed in 4.2% of children in pediatric centers, 7.8% in combined centers (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.20-1.81), and 11.2% in adult centers (aOR, 1.81; 95% CI, 1.48-2.22). After propensity matching, the estimated average tracheostomy rate would be 62.9% higher (95% CI, 37.7-88.1%) at combined centers and 85.3% higher (56.6-113.9%) at adult centers relative to pediatric centers. Tracheostomy patients had longer hospital stay in pediatric centers than combined (-4.4 days, -7.4 to -1.3 days) or adult (-4.0 days, -7.2 to -0.9 days) centers, but fewer children required postdischarge inpatient care (70.1% pediatric vs. 81.3% combined [aOR, 2.11; 95% CI, 1.03-4.31] and 82.4% adult centers [aOR, 2.51; 95% CI, 1.31-4.83]).

Conclusion: Children treated at pediatric trauma centers have lower likelihood of tracheostomy than children treated at combined adult/pediatric or adult centers independent of patient or injury characteristics. Better understanding of optimal indications for tracheostomy is necessary to improve processes of care for children treated throughout the pediatric trauma system.

Level of evidence: Prognostic and Epidemiological; Level III.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose

Figures

Figure 1:
Figure 1:. Frequency of tracheostomy by trauma center type.
Limited to facilities that treated ≥25 eligible pediatric trauma patients during the study period (n=263 facilities).
Figure 2:
Figure 2:. Frequency of tracheostomy placement by patient age and diagnosis, stratified by trauma center type.
ARDS, acute respiratory distress syndrome.
See this image and copyright information in PMC

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