title: Tracheostomy risk factors and outcomes after severe traumatic brain injury.
abstract: OBJECTIVE
  To determine risk factors associated with tracheostomy placement after severe traumatic brain injury (TBI) and subsequent outcomes among those who did and did not receive a tracheostomy.
  
  
  METHODS
  This retrospective cohort study compared adult trauma patients with severe TBI (n = 583) who did and did not receive tracheostomy. A multivariable logistic regression model assessed the associations between age, sex, race, insurance status, admission GCS, AIS (Head, Face, Chest) and tracheostomy placement. Ordinal logistic regression models assessed tracheostomy's influence on ventilator days and ICU LOS. To limit immortal time bias, Cox proportional hazards models assessed mortality at 1, 3 and 12-months.
  
  
  RESULTS
  In this multivariable model, younger age and private insurance were associated with increased probability of tracheostomy. AIS, ISS, GCS, race and sex were not risk factors for tracheostomy placement. Age showed a non-linear relationship with tracheostomy placement; likelihood peaked in the fourth decade and declined with age. Compared to uninsured patients, privately insured patients had an increased probability of receiving a tracheostomy (OR = 1.89 [95% CI = 1.09-3.23]). Mortality was higher in those without tracheostomy placement (HR = 4.92 [95% CI = 3.49-6.93]). Abbreviated injury scale-Head was an independent factor for time to death (HR = 2.53 [95% CI = 2.00-3.19]), but age, gender and insurance were not.
  
  
  CONCLUSIONS
  Age and insurance status are independently associated with tracheostomy placement, but not with mortality after severe TBI. Tracheostomy placement is associated with increased survival after severe TBI.
authors.affiliation: a Departments of Surgery and Neurosurgery, Division of Trauma & Surgical Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Humble
authors.affiliation: b Department of Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA.|c Department of Communication Sciences and Disorders , University of Tulsa , Tulsa , OK , USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Wilson
authors.affiliation: a Departments of Surgery and Neurosurgery, Division of Trauma & Surgical Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McKenna
authors.affiliation: a Departments of Surgery and Neurosurgery, Division of Trauma & Surgical Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Taylor C
authors.initials: TC
authors.lastname: Leath
authors.affiliation: d Department of Biostatistics.
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.affiliation: d Department of Biostatistics.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Davidson
authors.affiliation: e Departments of Anesthesiology , Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine , Nashville , TN , USA.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: a Departments of Surgery and Neurosurgery, Division of Trauma & Surgical Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.affiliation: e Departments of Anesthesiology , Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine , Nashville , TN , USA.|f Veterans Affairs (VA) Tennessee Valley Healthcare System , Nashville VA Medical Center , Nashville , TN , USA.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
authors.affiliation: a Departments of Surgery and Neurosurgery, Division of Trauma & Surgical Critical Care , Vanderbilt University Medical Center , Nashville , TN , USA.|b Department of Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA.|f Veterans Affairs (VA) Tennessee Valley Healthcare System , Nashville VA Medical Center , Nashville , TN , USA.
authors.forename: Mayur B
authors.initials: MB
authors.lastname: Patel
mesh_terms: D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014139:Tracheostomy / Q000379:methods*; D055815:Young Adult
keywords: Traumatic brain injury; insurance; outcome; tracheostomy; trauma