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Updated: Jan 20, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Early Tracheostomy for Severe Pediatric Traumatic Brain Injury is Associated with Reduced Intensive Care Unit Length
Brian M Sheehan1, Areg Grigorian1, Sahil Gambhir1
1Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, 8788University of California, Irvine, Orange, CA, USA.
Insights
Early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) significantly reduces intensive care unit (ICU) length of stay (LOS) and ventilator days. These findings suggest potential benefits for early intervention in TBI management.
Area of Science:
- Pediatric critical care medicine
- Neurosurgery
- Trauma surgery
Background:
- Severe traumatic brain injury (TBI) in children presents significant management challenges.
- Tracheostomy is a common intervention for airway management in critically ill pediatric patients.
- The optimal timing of tracheostomy in pediatric severe TBI remains an area of investigation.
Purpose of the Study:
- To evaluate the impact of early versus late tracheostomy on in-hospital outcomes in pediatric patients with severe TBI.
- To compare intensive care unit (ICU) length of stay (LOS), ventilator days, and total hospital LOS between early and late tracheostomy groups.
- To determine if early tracheostomy improves outcomes similar to findings in adult TBI patients.
Main Methods:
- Retrospective cohort analysis using the Pediatric Trauma Quality Improvement Program (TQIP) database.
- Inclusion of 127 pediatric patients (<16 years old) with severe TBI (Abbreviated Injury Scale >3) undergoing tracheostomy.
- Comparison of outcomes between early (days 1-6) and late (day ≥7) tracheostomy groups using statistical analyses (Student t test, Mann-Whitney U test, χ2).
Main Results:
- Early tracheostomy (n=16) was associated with significantly decreased ICU LOS (17 vs. 32 days) and ventilator days (9.7 vs. 27.1 days) compared to late tracheostomy (n=111).
- No significant differences were observed in total hospital LOS, incidence of acute respiratory distress syndrome, pneumonia, or mortality between the groups.
- Patient demographics, injury severity, and mechanism of injury were similar between early and late tracheostomy groups.
Conclusions:
- Early tracheostomy in pediatric severe TBI patients is associated with reduced ICU length of stay and fewer ventilator days.
- These findings align with outcomes observed in adult populations undergoing early tracheostomy for TBI.
- Further prospective studies are recommended to validate these results and establish definitive clinical guidelines.
Objectives:
To determine whether, similar to adults, early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) improves inhospital outcomes including ventilator days, intensive care unit (ICU) length of stay (LOS), and total hospital LOS when compared to late tracheostomy.
Design:
Retrospective cohort analysis.
Setting:
The Pediatric Trauma Quality Improvement Program (TQIP) database.
Patients:
One hundred twenty-seven pediatric patients <16 years old with severe (>3) abbreviated injury scale TBI who underwent early (days 1-6) or late (day ≥7) tracheostomy between 2014 and 2016.
Interventions:
Not applicable.
Measurements And Main Results:
The Pediatric TQIP database was queried for patients <16 years old with severe TBI, who underwent tracheostomy. Patient demographics and outcomes of early versus late tracheostomy were compared using Student t test, Mann-Whitney U test, and χ2 analysis. Sixteen patients underwent early tracheostomy while 111 underwent late tracheostomy. The groups had similar distributions of age, gender, mechanism of injury, and mean injury severity scores (P > .05). Early tracheostomy was associated with decreased ICU LOS (early: 17 vs late: 32 days, P < .05) and ventilator days (early: 9.7 vs late: 27.1 days, P < .05). There was no difference in total LOS (early: 26.7 vs late: 41.3 days, P = .06), the incidence of acute respiratory distress syndrome (early: 6.3% vs late: 2.7%, P = .45), pneumonia (early: 12.5% vs late: 29.7%, P = .15), or mortality (early: 0% vs late: 2%, P = .588) between the 2 groups.
Conclusion:
Similar to adults, early tracheostomy in pediatric patients with severe TBI is associated with decreased ICU LOS and ventilator days. Future prospective trials are needed to confirm these findings.
Article Tweet:
Early tracheostomy in pediatric patients with severe TBI is associated with decreased ICU LOS and ventilator days.
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