title: Early tracheostomy improves outcomes in severely injured children and adolescents.
abstract: BACKGROUND
  Early tracheostomy has been advocated for adult trauma patients to improve outcomes and resource utilization. We hypothesized that timing of tracheostomy for severely injured children would similarly impact outcomes.
  
  
  METHODS
  Injured children undergoing tracheostomy over a 10-year period (2002-2012) were reviewed. Early tracheostomy was defined as post-injury day ≤ 7. Data were compared using Student's t test, Pearson chi-squared test and Fisher exact test. Statistical significance was set at p<0.05 with 95% confidence intervals.
  
  
  RESULTS
  During the 10-year study period, 91 patients underwent tracheostomy following injury. Twenty-nine (32%) patients were < 12 years old; of these, 38% received early tracheostomy. Sixty-two (68%) patients were age 13 to 18; of these, 52% underwent early tracheostomy. Patients undergoing early tracheostomy had fewer ventilator days (p=0.003), ICU days (p=0.003), hospital days (p=0.046), and tracheal complications (p=0.03) compared to late tracheostomy. There was no difference in pneumonia (p=0.48) between early and late tracheostomy.
  
  
  CONCLUSIONS
  Children undergoing early tracheostomy had improved outcomes compared to those who underwent late tracheostomy. Early tracheostomy should be considered for the severely injured child.
  
  
  CONCLUSIONS
  Early tracheostomy is advocated for adult trauma patients to improve patient comfort and resource utilization. In a review of 91 pediatric trauma patients undergoing tracheostomy, those undergoing tracheostomy on post-injury day ≤ 7 had fewer ventilator days, ICU days, hospital days, and tracheal complications compared to those undergoing tracheostomy after post-injury day 7.
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: cmholscher@gmail.com.
authors.forename: Courtenay M
authors.initials: CM
authors.lastname: Holscher
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Camille L
authors.initials: CL
authors.lastname: Stewart
authors.affiliation: Denver Health Medical Center, Denver, CO, USA.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Peltz
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA; Denver Health Medical Center, Denver, CO, USA.
authors.forename: Clay Cothren
authors.initials: CC
authors.lastname: Burlew
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moulton
authors.affiliation: Denver Health Medical Center, Denver, CO, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Haenel
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA; Denver Health Medical Center, Denver, CO, USA. Electronic address: denis.bensard@dhha.org.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000601:surgery*; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Pediatrics; Tracheostomy; Trauma