title: Impact of tracheostomy timing on outcome after severe head injury.
abstract: BACKGROUND
  The influence of tracheostomy timing on outcome after severe head injury remains controversial.
  
  
  METHODS
  The investigation was based on data prospectively collected by the Pennsylvania Trauma Society Foundation statewide trauma registry from January 1990 until December 2005.
  
  
  RESULTS
  3,104 patients met criteria for inclusion in the study (GCS ≤ 8 and tracheostomy). Early Tracheostomy Group (ETG) patients, defined as tracheostomy performed during hospital days 1-7, were more likely to be functionally independent at discharge (adjusted odds ratio (OR) 1.45, 95% confidence interval (CI), 1.16-1.82, P = 0.001) and have a shorter length of stay (adjusted OR 0.23, 95% CI, 0.20-0.28, P < 0.0001). However, Late Tracheostomy Group (LTG) patients, defined as tracheostomy performed >7 days after admission, were approximately twice as likely to be discharged alive (adjusted OR 2.12, 95% CI, 1.60-2.82, P < 0.0001). Using a Composite Outcome Scale, which combined these three measures, there was a non-significant trend toward a higher likelihood of a poor outcome in LTG patients. When this analysis was repeated using only those patients in relatively good condition on admission, LTG patients were found to be approximately 50% less likely to have a good outcome (adjusted OR 0.46, 95% CI, 0.28-0.73, P = 0.001) when compared to ETG patients.
  
  
  CONCLUSIONS
  These results indicate a complex relationship between tracheostomy timing and outcome, but suggest that a strategy of early tracheostomy, particularly when performed on patients with a reasonable chance of survival, results in a better overall clinical outcome than when the tracheostomy is performed in a delayed manner.
authors.affiliation: Department of Neurosurgery-EC110, Penn State MS Hershey Medical Center, Penn State College of Medicine, PO Box 859, Hershey, PA, USA.
authors.forename: Elias B
authors.initials: EB
authors.lastname: Rizk
authors.forename: Akshal S
authors.initials: AS
authors.lastname: Patel
authors.forename: Christina M
authors.initials: CM
authors.lastname: Stetter
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Cockroft
mesh_terms: D015998:Abbreviated Injury Scale; D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult