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Updated: Jan 27, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Timing of tracheostomy placement among children with severe traumatic brain injury: A propensity-matched analysis
Cory McLaughlin1, David Darcy, Caron Park
1From the Division of Pediatric Surgery (C.M., D.D., D.W.B., J.S.U.), Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery (D.W.B., J.S.U.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Southern California Clinical and Translational Science Institute (SC-CTSI) (C.P., C.J.L., W.J.M.), Los Angeles, California; Department of Preventive Medicine (C.P., C.J.L., W.J.M.), Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Critical Care Medicine (A.B.), Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics (A.B.), Keck School of Medicine of the University of Southern California, Los Angeles, California; American College of Surgeons (A.B.N.), Chicago, Illinois; Department of Surgery (A.B.N.), University of Toronto, Toronto, Ontario, Canada; Division of Burn and Trauma Surgery (R.S.B.), Children's National Medical Center, Washington, District of Columbia; and Division of Pediatric General Surgery (A.R.J.), UCSF Benioff Children's Hospital Oakland, Oakland, California.
Insights
Early tracheostomy in children with severe traumatic brain injury (TBI) is linked to shorter hospital stays and fewer complications. Extubation without tracheostomy is uncommon after 18 days post-injury.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Neurocritical care
Background:
- Early tracheostomy is beneficial in adult trauma patients, reducing hospital stay and complications.
- Established guidelines for tracheostomy in pediatric severe traumatic brain injury (TBI) are lacking.
- This study investigates nationwide trends and outcomes of tracheostomy in children with severe TBI.
Purpose of the Study:
- To define national trends in extubation and tracheostomy timing for pediatric severe TBI.
- To assess the association between early tracheostomy and reduced length of stay.
- To determine if early tracheostomy decreases complication rates in children with severe TBI.
Main Methods:
- Utilized the National Trauma Data Bank (2007-2015) for children (<15 years) with severe TBI (head AIS ≥3) requiring mechanical ventilation (>48 hours).
- Employed 1:1 propensity score matching to compare outcomes between early (≤14 days) and late (≥15 days) tracheostomy groups.
- Controlled for confounding factors including age, vital signs, GCS motor score, injury characteristics, and interventions.
Main Results:
- Out of 6,101 children, 361 (6%) underwent tracheostomy at a median of 15 days; 94% were extubated or died within 18 days.
- Early tracheostomy (matched pairs) correlated with significantly fewer ventilator days, ICU days, and hospital days.
- Complications such as pneumonia, venous thromboembolism, and decubitus ulcers were less frequent with early tracheostomy.
Conclusions:
- Early tracheostomy in pediatric severe TBI patients is associated with improved outcomes, including shorter hospitalizations and reduced complications.
- Extubation without tracheostomy beyond 18 days post-injury is infrequent in this population.
Background:
Early tracheostomy has been associated with shorter hospital stay and fewer complications in adult trauma patients. Guidelines for tracheostomy have not been established for children with severe traumatic brain injury (TBI). The purpose of this study was to (1) define nationwide trends in time to extubation and time to tracheostomy and (2) determine if early tracheostomy is associated with decreased length of stay and fewer complications in children with severe TBI.
Methods:
Records of children (<15 years) with severe TBI (head Abbreviated Injury Severity [AIS] score ≥3) who were mechanically ventilated (>48 hours) were obtained from the National Trauma Data Bank (2007-2015). Outcomes after early (≤14 days) and late (≥15 days) tracheostomy placement were compared using 1:1 propensity score matching to control for potential confounding by indication. Propensity scores were calculated based on age, race, pulse, blood pressure, Glasgow Coma Scale motor score, injury mechanism, associated injury Abbreviated Injury Severity scores, TBI subtype, craniotomy, and intracranial pressure monitor placement.
Results:
Among 6,101 children with severe TBI, 5,740 (94%) were extubated or died without tracheostomy, 95% of the time within 18 days. Tracheostomy was performed in 361 children (6%) at a median [interquartile range] of 15 [10, 22] days. Using propensity score matching, we compared 121 matched pairs with early or late tracheostomy. Early tracheostomy was associated with fewer ventilator days (14 [9, 19] vs. 25 [19, 35]), intensive care unit days (19 [14, 25] vs. 31 [24, 43]), and hospital days (26 [19, 41] vs. 39 [31, 54], all p < 0.05). Pneumonia (24% vs. 41%), venous thromboembolism (3% vs. 13%), and decubitus ulcer (4% vs. 13%) occurred less frequently with early tracheostomy (p < 0.05).
Conclusions:
Early tracheostomy is associated with shorter hospital stay and fewer complications among children with severe TBI. Extubation without tracheostomy is rare beyond 18 days after injury.
Level Of Evidence:
Prognostic and epidemiological, retrospective comparative study, level III.
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