title: Optimal timing of surgical intervention following adult laryngeal trauma.
abstract: OBJECTIVE
  Laryngeal trauma is an infrequent diagnosis with a scarcity of published data. We aim to further define the factors associated with positive surgical outcomes of adult laryngeal trauma.
  
  
  METHODS
  Multi-institution database analysis.
  
  
  METHODS
  Of the 1.9 million trauma cases from the National Trauma Database (NTDB), 564 adult trauma events were selected with ICD-9 codes specific to laryngeal trauma.
  
  
  RESULTS
  Laryngeal trauma was seen predominately in white (61.5%), middle-aged (40.6 years), male (83.7%) patients experiencing blunt (70.7%) laryngeal injury with multiorgan system (92.2%) trauma. There was an overall 17.9% mortality rate. Within the 564 cases, 133 direct laryngoscopies, 185 tracheostomies, 53 laryngeal suturing, and 60 laryngeal fracture repairs were performed. In univariate negative binomial regression models, trauma severity (P ≤ .01), placement of tracheostomy (P lt; .01), and delayed tracheostomy placement (P = .04, .03, .048) were associated with increased ventilator dependence, intensive care unit (ICU) stay, and overall hospital admission duration. Multivariate regression models demonstrated significant associations between tracheostomy performed within 24 hours and shortened ICU stay (P = .03, β = -.28, SE = 1.7) and overall hospital stay (P = .009, β = -.23, SE = 3.1).
  
  
  CONCLUSIONS
  The NTDB allows study of the largest laryngeal trauma cohort in modern literature. Although complexities arise in the treatment of laryngeal traumas, when indicated, surgical airway should be placed within 24 hours of presentation to improve the overall hospital course.
authors: Division of Head & Neck Surgery, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California 90035, USA. AMendelsohn@mednet.ucla.edu
authors: Abie H
authors: AH
authors: Mendelsohn
authors: Douglas R
authors: DR
authors: Sidell
authors: Gerald S
authors: GS
authors: Berke
authors: Maie St
authors: MS
authors: John
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods; D007830:Larynx / Q000293:injuries* / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*