Impact of tracheostomy timing on outcome after severe head injury

Neurocrit Care. 2011 Dec;15(3):481-9. doi: 10.1007/s12028-011-9615-7.


Background: The influence of tracheostomy timing on outcome after severe head injury remains controversial.

Methods: The investigation was based on data prospectively collected by the Pennsylvania Trauma Society Foundation statewide trauma registry from January 1990 until December 2005.

Results: 3,104 patients met criteria for inclusion in the study (GCS ≤ 8 and tracheostomy). Early Tracheostomy Group (ETG) patients, defined as tracheostomy performed during hospital days 1-7, were more likely to be functionally independent at discharge (adjusted odds ratio (OR) 1.45, 95% confidence interval (CI), 1.16-1.82, P = 0.001) and have a shorter length of stay (adjusted OR 0.23, 95% CI, 0.20-0.28, P < 0.0001). However, Late Tracheostomy Group (LTG) patients, defined as tracheostomy performed >7 days after admission, were approximately twice as likely to be discharged alive (adjusted OR 2.12, 95% CI, 1.60-2.82, P < 0.0001). Using a Composite Outcome Scale, which combined these three measures, there was a non-significant trend toward a higher likelihood of a poor outcome in LTG patients. When this analysis was repeated using only those patients in relatively good condition on admission, LTG patients were found to be approximately 50% less likely to have a good outcome (adjusted OR 0.46, 95% CI, 0.28-0.73, P = 0.001) when compared to ETG patients.

Conclusions: These results indicate a complex relationship between tracheostomy timing and outcome, but suggest that a strategy of early tracheostomy, particularly when performed on patients with a reasonable chance of survival, results in a better overall clinical outcome than when the tracheostomy is performed in a delayed manner.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abbreviated Injury Scale
  • Activities of Daily Living / classification
  • Adolescent
  • Adult
  • Brain Injuries / mortality
  • Brain Injuries / therapy*
  • Female
  • Glasgow Coma Scale / statistics & numerical data
  • Humans
  • Injury Severity Score
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Odds Ratio
  • Outcome and Process Assessment, Health Care
  • Pennsylvania
  • Prospective Studies
  • Registries
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • Tracheostomy / methods*
  • Tracheostomy / statistics & numerical data
  • Young Adult