title: Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression.
abstract: OBJECTIVE
  Patients with severe traumatic brain injury (TBI) frequently require a tracheostomy for prolonged mechanical ventilation and/or pulmonary toilet. It is now proven that the earlier the procedure is done, the more beneficial it is to the patient. The present study was carried out to determine if the requirement of a tracheostomy can be predicted on arrival of a patient to the emergency department. The prediction can potentially aid in combining the procedure with cranial decompression. In this study, the authors' aim was to determine the emergency department predictors of tracheostomy in patients with isolated TBI requiring emergency cranial decompression.
  
  
  METHODS
  The authors performed a retrospective chart review of all patients who underwent surgery for isolated TBI and required more than 4 days of mechanical ventilation. Multivariate logistic regression analysis was used for predictive indicators.
  
  
  RESULTS
  In patients with isolated severe TBI, a patient age of 31-50 years, the presence of preexisting medical comorbid conditions, a delay in emergency department arrival exceeding 1.5 hours, an abnormal pupil response on arrival, and a preoperative neurological worsening during hospital stay were independent predictors of the requirement for tracheostomy. These findings were validated in a small cohort of patients and were found to be significant.
  
  
  CONCLUSIONS
  Requirement of a tracheostomy can be predicted in patients with severe TBI on arrival to the emergency department. These results were validated in a small cohort of patients, and it was found that the positive predictive value of requirement of tracheostomy was directly proportional to the number of predictors present. Larger prospective studies with appropriate control groups are further recommended to validate the authors' findings.
authors.affiliation: Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. shahzad.shamim@aku.edu
authors.forename: Muhammad Shahzad
authors.initials: MS
authors.lastname: Shamim
authors.forename: Mohsin
authors.initials: M
authors.lastname: Qadeer
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.forename: S Ather
authors.initials: SA
authors.lastname: Enam
authors.forename: Najiha B
authors.initials: NB
authors.lastname: Farooqi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000601:surgery*; D016022:Case-Control Studies; D002648:Child; D019299:Decompression, Surgical; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014139:Tracheostomy