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Published on: January 17, 2011
Timing of Initial Posttracheostomy Surveillance Endoscopy in Pediatric Patients
Matthew M Smith1,2, Alessandro de Alarcon1,2, Jareen Meinzen-Derr3
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
The optimal timing for the first post-tracheostomy microlaryngoscopy and bronchoscopy (MLB) in children is when tracheostomy-related symptoms appear. This approach maximizes the clinical yield of the procedure for medical or surgical decision-making.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pediatric Surgery
Background:
- Tracheostomy is a common procedure in pediatric patients.
- The timing of the first posttracheostomy microlaryngoscopy and bronchoscopy (MLB) is not well-established.
- Early surveillance may lead to unnecessary procedures, while delayed surveillance may miss critical findings.
Purpose of the Study:
- To determine the optimal timing for the initial posttracheostomy microlaryngoscopy and bronchoscopy (MLB) in pediatric patients.
- To evaluate the clinical yield of MLB based on its timing.
- To identify predictors of medical or surgical decision-making following MLB.
Main Methods:
- Retrospective case series with chart review of 202 pediatric patients (<21 years) who underwent tracheostomy.
- Patients were categorized into early (<6 weeks) and late (6-14 weeks) posttracheostomy MLB surveillance groups.
- Primary outcome was the clinical yield, defined by medical or surgical treatment decisions based on MLB findings.
Main Results:
- No significant difference in medical or surgical decision-making between early (21.5%) and late (19%) MLB groups (P = .49).
- The presence of tracheostomy-related symptoms prior to MLB was the sole predictor of a treatment decision (OR, 6.75; 95% CI, 2.78-16.39).
- 202 patients were analyzed, with 162 in the early group and 40 in the late group.
Conclusions:
- The timing of the first posttracheostomy MLB did not significantly impact medical or surgical decision-making.
- Tracheostomy-related symptoms are predictive of the clinical utility of the initial MLB.
- Recommend initiating surveillance endoscopy upon the onset of tracheostomy-related symptoms in pediatric patients.
Objective:
To determine the optimal timing of the first posttracheostomy microlaryngoscopy and bronchoscopy (MLB).
Study Design:
Case series with chart review.
Setting:
Tertiary pediatric medical center.
Subjects And Methods:
Patients (<21 years of age) who underwent tracheostomy placement from January 1, 2011, to December 31, 2016. Patients were divided into early and late posttracheostomy surveillance groups (<6 weeks vs 6 to 14 weeks, respectively) based on the timing of their first posttracheostomy MLB. The primary outcome was to ascertain the clinical yield of the initial posttracheostomy MLB by documenting whether a medical or surgical treatment decision was made based on MLB findings.
Results:
In total, 202 patients were included; of these patients, 162 met criteria for placement in the early group and 40 met criteria for the late group. There was no significant difference between the early and late groups regarding whether a medical or surgical decision was made at the time of the first MLB (21.5% vs 19%, respectively; P = .49). Multiple logistic regression identified that the presence of tracheostomy-related symptoms prior to MLB (odds ratio, 6.75; 95% confidence interval, 2.78-16.39) was the sole predictor of a medical or surgical decision being made at the first posttracheostomy MLB.
Conclusion:
The presence of tracheostomy-related symptoms was predictive of a medical or surgical decision being made using information obtained at the time of the first posttracheostomy MLB. We thus recommend that surveillance endoscopy be initiated when tracheotomized children start to develop tracheostomy-related symptoms.
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