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World Neurosurg. 2017 Jul;103:88-93. doi: 10.1016/j.wneu.2017.02.060. Epub 2017 Feb 22.

Experience with Traumatic Brain Injury: Is Early Tracheostomy Associated with Better Prognosis?

Author information

1
Shiraz Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
2
Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
3
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
4
Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Non-communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran. Electronic address: peyman.arasteh@yahoo.com.
5
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
6
Medical Imaging Research Center, Department of Radiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

OBJECTIVE:

In this study we compared the effects of early tracheostomy (ET) versus late tracheostomy on traumatic brain injury (TBI)-related outcomes and prognosis.

PATIENTS AND METHODS:

Data on 152 TBI patients with a Glasgow Coma Scale (GCS) score of ≤8, admitted to Rajaee Hospital between March 1, 2014 and August 23, 2015, were collected. Rajaee Hospital is the main referral trauma center in southern Iran and is affiliated with Shiraz University of Medical Sciences. Patients who had tracheostomy before or at the sixth day of their admission were considered as ET, and those who had tracheostomy after the sixth day of admission were considered as late tracheostomy.

RESULTS:

Patients with ET had a significantly lower hospital stay (46.4 vs. 38.6 days; P = 0.048) and intensive care unit stay (34.9 vs. 26.7 days; P = 0.003). Mortality rates were not significantly different between the 2 groups (P > 0.99). Although not statistically significant, favorable outcomes (Glasgow Outcome Scale >4) were higher and ventilator-associated pneumonia rates were lower among the ET group (P = 0.346 and P = 492, respectively). Multivariate analysis showed that ET significantly improves 6-month prognosis (Glasgow Outcome Scale >4) (odds ratio = 2.535; 95% confidence interval: 1.030-6.237). Higher age was inversely associated with favorable prognosis (odds ratio = -0.958; confidence interval: 0.936-0.981). Glasgow Coma Scale and Rotterdam score did not show any effect on 6-month prognosis.

CONCLUSION:

Despite previous concern regarding increased mortality rates among patients who undergo ET, performing a tracheostomy for patients with severe TBI <6 days after their hospital admission, in addition to decreasing hospital and intensive care unit stays, will improve patient prognosis.

KEYWORDS:

Brain injury; Outcome; Prognosis; Tracheostomy; Trauma

PMID:
28254541
DOI:
10.1016/j.wneu.2017.02.060
[Indexed for MEDLINE]

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