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Baron, DM; Hochrieser, H; Metnitz, PG; Mauritz, W.
Tracheostomy is associated with decreased hospital mortality after moderate or severe isolated traumatic brain injury.
Wien Klin Wochenschr. 2016; 128(11-12):397-403 Doi: 10.1007/s00508-016-1004-y [OPEN ACCESS]
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Metnitz Philipp

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Data regarding the impact and timing of tracheostomy in patients with isolated traumatic brain injury (TBI) are ambiguous. Our goal was to evaluate the impact of tracheostomy on hospital mortality in patients with moderate or severe isolated TBI. We performed a retrospective cohort analysis of data prospectively collected at 87 Austrian intensive care units (ICUs). All patients continuously admitted between 1998 and 2010 were evaluated for the study. In total, 4,735 patients were admitted to ICUs with isolated TBI. Of these patients, 2,156 had a moderate or severe TBI (1,603 patients were endotracheally intubated only, 553 patients underwent tracheostomy). Epidemiological data (trauma severity, treatment, and outcome) of the two groups were compared. Patients with moderate or severe isolated TBI undergoing tracheostomy had a similar Glasgow Coma Scale score, median (interquartile range): 6 (3-8) vs 6 (3-8); p = 0.90, and Simplified Acute Physiology Score II, 45 (37-54) vs 45 (35-56); p = 0.86, compared with intubated patients not undergoing tracheostomy. Furthermore, patients undergoing tracheostomy exhibited higher Abbreviated Injury Scale Head scores and had a longer ICU stay for survivors, 30 (22-42) vs 9 (3-17) days; p < 0.0001). In contrast, risk-adjusted mortality was lower in patients undergoing tracheostomy compared with patients who remained intubated, observed-to-expected mortality ratio (95 % confidence interval): 0.62 (0.53-0.72) vs 1.00 (0.95-1.05) respectively. Despite the greater severity of head injury, patients with isolated TBI who underwent tracheostomy had a lower risk-adjusted mortality than patients who remained intubated. Reasons for this difference in outcome may be multifactorial and require further investigation.
Find related publications in this database (using NLM MeSH Indexing)
Adult -
Aged -
Austria - epidemiology
Brain Injuries, Traumatic - diagnosis
Brain Injuries, Traumatic - mortality
Brain Injuries, Traumatic - surgery
Female -
Hospital Mortality -
Humans -
Incidence -
Male -
Middle Aged -
Respiratory Insufficiency - mortality
Respiratory Insufficiency - prevention & control
Retrospective Studies -
Risk Factors -
Survival Rate -
Tracheostomy - mortality
Tracheostomy - statistics & numerical data
Trauma Severity Indices -
Treatment Outcome -

Find related publications in this database (Keywords)
Isolated traumatic brain injury
Hospital mortality
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