Utilization of tracheostomy among geriatric trauma patients and association with mortality

Early Tracheostomy in Older Trauma Patient Is Associated With Comparable Outcomes to Younger Cohort

INTRODUCTION

Early tracheostomy (ET) is associated with a lower incidence of pneumonia (PNA) and mechanical ventilation duration (MVD) in hospitalized patients with trauma. The purpose of this study is to determine if ET also benefits older adults compared to the younger cohort.

METHODS

Adult hospitalized trauma patients who received a tracheostomy as registered in The American College of Surgeons Trauma Quality Improvement Program from 2013 to 2019 were analyzed. Patients with tracheostomy prior to admission were excluded. Patients were stratified into 2 cohorts consisting of those aged ≥65 and those aged <65. These cohorts were analyzed separately to compare the outcomes of ET (<5 d; ET) versus late tracheostomy (LT) (≥5 d; LT). The primary outcome was MVD. Secondary outcomes were in-hospital mortality, hospital length of stay (HLOS), and PNA. Univariate and multivariate analyses were performed with significance defined as P value < 0.05.

RESULTS

In patients aged <65, ET was performed within a median of 2.3 d (interquartile range, 0.47-3.8) after intubation and a median of 9.9 d (interquartile range, 7.5-13) in the LT group. The ET group's Injury Severity Score was significantly lower with fewer comorbidities. There were no differences in injury severity or comorbidities when comparing the groups. ET was associated with lower MVD (d), PNA, and HLOS on univariate and multivariate analyses in both age cohorts, although the degree of benefit was higher in the less than 65 y cohort [ET versus LT MVD: 5.08 (4.78-5.37), P < 0.001; PNA: 1.45 (1.36-1.54), P < 0.001; HLOS: 5.48 (4.93-6.04), P < 0.001]. Mortality did not differ based on time to tracheostomy.

CONCLUSIONS

ET is associated with lower MVD, PNA, and HLOS in hospitalized patients with trauma regardless of age. Age should not factor into timing for tracheostomy placement.

[Management of thoracic trauma and intrathoracic injuries]

More than 45% of polytraumatized patients in Germany suffer from severe thoracic trauma. Due to the urgent time factor (e.g. respiratory insufficiency and severe bleeding), a structured procedure in the diagnostics and treatment according to the advanced trauma life support (ATLS) criteria is necessary both prehospital and in the emergency room in order to provide the patient with adequate care. If a patient is stable or can be stabilized there is the option of using extended diagnostics, such as whole body computer tomography (CT) scanning with contrast medium, to select a treatment that is optimally adapted to the injury pattern. This can be performed by open surgery, minimally invasive surgery and interventional radiologically/endoscopically and depends on the injured organ as well as the extent of the injury. This means that only an interdisciplinary approach guarantees optimal care for patients with thoracic trauma.