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Predicting the Need for Early Tracheostomy: A Multifactorial Analysis of 992 Intubated Trauma Patients

Goettler, Claudia E. MD, FACS; Fugo, Jonathan R. DO; Bard, Michael R. MD; Newell, Mark A. MD, FACS; Sagraves, Scott G. MD, FACS; Toschlog, Eric A. MD, FACS; Schenarts, Paul J. MD, FACS; Rotondo, Michael F. MD, FACS

Journal of Trauma-Injury Infection & Critical Care:
doi: 10.1097/01.ta.0000217270.16860.32
Original Articles

Background: Tracheostomy has few, severe risks, while prolonged endotracheal intubation causes morbidity. The need for tracheostomy was assessed, based on early clinical parameters.

Methods: Adult trauma patients (January 1994–August 2004), intubated for resuscitation, ventilated >24 hours, were retrospectively evaluated for demographics, physiology, brain, and pulmonary injury. Tracheostomy patients were compared with those without. Chi-square, Mann-Whitney, and multivariate logistic regression were used with statistical significance at p < 0.05.*

Results: Of 992 patients, 430 (43%) underwent tracheostomy at 9.22 ± 5.7 days. Risk factors were age (45.6* ± 18.8 vs. 36.7 ± 15.9, OR: 2.1 (18 years increments), ISS (30.3* ± 12.5 vs. 22.0 ± 10.3, OR: 2.1 (12u increments), damage control (DC) [68%*(n = 51) vs. 32%*(n = 51), OR: 3.8], craniotomy [70%*(n = 21) versus 30%(n = 9), OR: 2.6], and intracranial pressure monitor (ICP) [65.4%*(n = 87) vs. 34.6%(n = 46), OR: 2.1].

A 100% tracheostomy rate (n = 30, 3.0%) occurred with ISS (injury severity score) = 75, ISS ≥50, and age ≥55, admit/24 hour GCS (Glasgow Coma Scale) = 3 and age ≥70, AIS abdomen, chest or extremities ≥5 and age ≥60, bilateral pulmonary contusions (BPC) and ≥8 rib fractures, craniotomy and age ≥50, craniotomy with intracranial pressure (ICP) and age ≥40, or craniotomy and GCS ≤4 at 24 hour.

A tracheostomy rate of ≥90% (n = 105, 10.6%) was found with ISS ≥54, ISS ≥40, and age ≥40, admit/24 hour GCS = 3 and age ≥55, paralysis and age ≥40, BPC and age ≥55.

A tracheostomy rate ≥80% (n = 248, 25.0%) occurred with ISS ≥38, age ≥80, admit/24 hour GCS = 3 and age ≥45, DC and age ≥50, BPC and age ≥50, aspiration and age ≥55, craniotomy with ICP, craniotomy with GCS ≤9 at 24 hour.

Conclusion: Discrete risk factors predict the need for tracheostomy for trauma patients. We recommend that patients with ≥90% risk undergo early tracheostomy and that it is considered in the ≥80% risk group to potentially decreased morbidity, increased patient comfort, and optimize resource utilization.

Author Information

From the Department of Surgery, East Carolina University, Greenville, North Carolina.

Submitted for publication October 6, 2005.

Accepted for publication February 22, 2006.

Presented as a poster at the 64th Annual Meeting of the American Association for the Surgery of Trauma, September 22–24, 2005, Atlanta, Georgia.

Address for reprints: Claudia E. Goettler, MD, FACS, Trauma 2ED, 600 Moye Boulevard, Greenville, NC 27858-354; email:

© 2006 Lippincott Williams & Wilkins, Inc.