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Published on: May 18, 2019
Mortality Among Children with a Tracheostomy
Taylor B Teplitzky1, Ashley F Brown2, Rebecca L Brooks2
1Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Children with tracheostomies have a 16.8% mortality rate, with many deaths occurring during the initial hospital stay. Tracheostomy complications, though infrequent, highlight areas for quality improvement.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Medical device safety
Background:
- Tracheostomy is a common procedure in pediatric care for airway management.
- Understanding mortality patterns in children with tracheostomies is crucial for improving outcomes.
Purpose of the Study:
- To characterize the causes and circumstances of death in pediatric patients with tracheostomies.
Main Methods:
- A prospective cohort study included pediatric patients (<18 years) who underwent tracheostomy between 2015 and 2020.
- Data collected included demographics, tracheostomy placement details, cause and location of death, and time to mortality.
Main Results:
- The overall mortality rate was 16.8% (46 deaths out of 271 tracheostomies).
- Respiratory failure was the leading cause of death (33%), followed by cardiopulmonary arrest (15%).
- A significant proportion of deaths (28%) occurred during the same admission as tracheostomy placement; 9% were linked to tracheostomy-related complications.
Conclusions:
- Nearly one-third of pediatric deaths post-tracheostomy occur during the initial hospitalization.
- While underlying disease progression is primary, tracheostomy-related complications, though rare, warrant focused quality improvement efforts.
Objectives:
To characterize the cause of death among children with a tracheostomy.
Study Design:
Prospective cohort.
Methods:
All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age.
Results:
A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy-related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59-10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24-4.48) correlated with time to death on Cox proportional hazard modeling.
Conclusions:
Nearly one-third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy-related complication, which represents a meaningful target for quality improvement initiatives.
Level Of Evidence:
3 Laryngoscope, 133:403-409, 2023.
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