title: Optimal timing of tracheostomy after trauma without associated head injury.
abstract: BACKGROUND
  Controversy exists over optimal timing of tracheostomy in patients with respiratory failure after blunt trauma. The study aimed to determine whether the timing of tracheostomy affects mortality in this population.
  
  
  METHODS
  The 2008-2011 National Trauma Data Bank was queried to identify blunt trauma patients without concomitant head injury who required tracheostomy for respiratory failure between hospital days 4 and 21. Restricted cubic spline analysis was performed to evaluate the relationship between tracheostomy timing and the odds of inhospital mortality. The cohort was stratified based on this analysis. Unadjusted characteristics and outcomes were compared. Multivariable logistic regression was used to evaluate the effect of tracheostomy timing on mortality after adjustment for age, gender, race, payor status, level of trauma center, injury severity score, presentation Glasgow coma scale, and thoracic and abdominal abbreviated injury score.
  
  
  RESULTS
  There were 9662 patients included in the study. Restricted cubic spline analysis demonstrated a nonlinear relationship between timing of tracheostomy and mortality, with higher odds of mortality occurring with tracheostomy placement within 10 d of admission compared with later time points. The cohort was therefore stratified into early and delayed tracheostomy groups relative to this time point. The resulting groups contained 5402 (55.9%) and 4260 (44.1%) patients, respectively. After multivariable adjustment, the delayed tracheostomy group continued to have significantly reduced odds of mortality (Adjusted odds ratio, 0.82, 95% confidence interval, 0.71-0.95, C-statistic, 0.700).
  
  
  CONCLUSIONS
  Among non-head injured blunt trauma patients with prolonged respiratory failure, tracheostomy placement within 10 d of admission may result in increased mortality compared with later time points.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Vaslef
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Shapiro
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: john.scarborough@dm.duke.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Scarborough
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality
keywords: National Trauma Data Bank; Respiratory failure; Timing; Tracheostomy; Trauma