PURPOSE: The purpose of this study is to evaluate the impact of early tracheostomy on mortality in patients with blunt chest trauma.
METHODS: Patient information was retrieved from the National Trauma Data Bank Research Data Set v7.1. The inclusion criteria were: 1) Blunt chest injury (more than 3 rib fractures with or without hemo/pneumothorax) identified via the Abbreviated Injury Scale (AIS) codes with AIS score ≥3, 2) age between 18 and 89 years 3) survived for 48 hours, Patients with severe head injury (AIS ≥ 3) were excluded. In hospital mortality was the outcome. Early tracheostomy was defined as the procedure performed ≤7 days after ED arrival, and late tracheostomy as >7 days. Descriptive statistics were used to summarize patient characteristics and clinical outcomes. Wilcoxon rank-sum test and chi-square test was used to compare the continuous variables and categorical variables between early and late tracheostomy groups, respectively. Multiple logistic regression models were used to assess the association between the timing of tracheostomy and mortality while controlling for potential confounding factors.
RESULTS: Data from 406 severe blunt chest injury patients who admitted during 2002-2006 were evaluated. The overall mortality was 7.1%. The patients who died had older age (mean[SD]: 64.7[11.5] vs. 51.5[17.7] years P< 0.0001). But there was no statistical significant difference on gender (P=0.80), race (P=0.48), ISS scores (30.1[11.3] vs. 29.6[10.5], P=0.75), ED GCS score (12.6[4.7] vs. 11.2[5.1], P=0.056), and the timing of the tracheostomy (14.9[11.7] vs. 11.2[8.0] days, P=0.20). From a multivariate logistic regression model, there was a significant association between age and mortality (odds ratio=1.06, P< 0.0001). However, the timing of tracheostomy did not significantly associated with mortality (late vs. early tracheostomy, odds ratio=1.85, 95% confidence interval [0.73, 4.66]).
CONCLUSION: There was no significant association between the mortality and the timing of the tracheostomy in blunt severe chest injury patients.
CLINICAL IMPLICATIONS: Early tracheostomy does not improve mortality following massive chest trauma.Therefore clinical judgement should be applied and follow the guidlines for tracheostomy.
DISCLOSURE: Nasim Ahmed, No Financial Disclosure Information; No Product/Research Disclosure Information