Kartik Prabhakaran1, Asad Azim2, Muhammad Khan3, Faisal Jehan4, James Feeney5, Patrice Anderson6, Anthony Policastro7, Rifat Latifi8. 1. Westchester Medical Center, New York Medical College, 100 Woods Road, Taylor Pavilion, Office E15, Department of Surgery, Valhalla, NY, 10595, USA. Electronic address: Kartik.prabhakaran@wmchealth.org. 2. Westchester Medical Center, Department of Surgery, Taylor Pavilion, Room E-130, Center100 Woods Road, Valhalla, NY, 10595, USA. Electronic address: Asad.Azim@wmchealth.org. 3. Westchester Medical Center, Department of Surgery, Taylor Pavilion, Room E-130, Center100 Woods Road, Valhalla, NY, 10595, USA. Electronic address: Muhammad.Khan@wmchealth.org. 4. Westchester Medical Center, Department of Surgery, Taylor Pavilion, Room E-130, Center100 Woods Road, Valhalla, NY, 10595, USA. Electronic address: Faisal.Jehan@wmchealth.org. 5. MidHudson Regional Hospital, Westchester Medical Center, 241 North Road, Poughkeepsie, NY, 12601, USA. Electronic address: James.Feeney@wmchealth.org. 6. Trauma Intensive Care Unit, Surgical Critical Care Fellowship, 100 Woods Road, Taylor Pavilion, Office E145, Westchester Medical Center, Department of Surgery, Valhalla, NY, 10595, USA. Electronic address: PatriceLynn.Anderson@wmchealth.org. 7. Trauma Intensive Care Unit, Surgical Critical Care Fellowship, 100 Woods Road, Taylor Pavilion, Office E136, Westchester Medical Center, Department of Surgery, Valhalla, NY, 10595, USA. Electronic address: Anthony.Policastro@wmchealth.org. 8. Department of Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Taylor Pavilion, Office Suite #353, Valhalla, NY, 10595, USA. Electronic address: Rifat.Latifi@wmchealth.org.
Abstract
BACKGROUND: Early tracheostomy is recommended in patients with severe traumatic brain injury (TBI); however, predicting the timing of tracheostomy in trauma patients without severe TBI can be challenging. METHODS: A one year retrospective analysis of all trauma patients who were admitted to intensive Care Unit for > 7 days was performed, using the ACS-TQIP database. Univariate and Multivariate regression analyses were performed to assess the appropriate weight of each factor in determining the eventual need for early tracheostomy. RESULTS: A total of 21,663 trauma patients who met inclusion and exclusion criteria were identified. Overall, tracheostomy was performed in 18.3% of patients. On multivariate regression analysis age >70, flail chest, major operative intervention, ventilator days >5 days and underlying COPD were independently associated with need of tracheostomy. Based on these data, we developed a scoring system to predict risk for requiring tracheostomy. CONCLUSION: Age >70, presence of flail chest, need for major operative intervention, ventilator days >5 and underlying COPD are independent predictors of need for tracheostomy in trauma patients without severe TBI.
BACKGROUND: Early tracheostomy is recommended in patients with severe traumatic brain injury (TBI); however, predicting the timing of tracheostomy in traumapatients without severe TBI can be challenging. METHODS: A one year retrospective analysis of all traumapatients who were admitted to intensive Care Unit for > 7 days was performed, using the ACS-TQIP database. Univariate and Multivariate regression analyses were performed to assess the appropriate weight of each factor in determining the eventual need for early tracheostomy. RESULTS: A total of 21,663 traumapatients who met inclusion and exclusion criteria were identified. Overall, tracheostomy was performed in 18.3% of patients. On multivariate regression analysis age >70, flail chest, major operative intervention, ventilator days >5 days and underlying COPD were independently associated with need of tracheostomy. Based on these data, we developed a scoring system to predict risk for requiring tracheostomy. CONCLUSION: Age >70, presence of flail chest, need for major operative intervention, ventilator days >5 and underlying COPD are independent predictors of need for tracheostomy in traumapatients without severe TBI.