Comparison of Outcomes in Early- and Late-Tracheostomised Head Injury Patients

Early tracheostomy (ET) has been associated with improved airway stability and reduced complications in mechanically ventilated patients. Its optimal timing in severe traumatic brain injury (TBI) remains debated, particularly because outcomes may be influenced by baseline neurological severity, associated injuries, and clinical selection for tracheostomy timing.

The study aimed to compare unadjusted clinical outcomes between ET (<4 days) and late tracheostomy (LT) (>4 days) in patients with severe head injury and a Glasgow Coma Scale (GCS) score <8.

This retrospective comparative study included 120 patients with severe TBI managed over 18 months. Patients were classified into ET (n=60) and LT (n=60) groups based on the timing of the procedure. Outcomes analysed included duration of mechanical ventilation (MV), intensive care unit (ICU) stay, hospital stay, time to ward transfer, ventilator-associated pneumonia (VAP), and final clinical outcome. The analysis was unadjusted, and multivariable regression was not performed because complete covariate data for injury severity, associated injuries, sedation exposure, respiratory status, and weaning-related factors were not uniformly available in the retrospective records. Statistical significance was set at p<0.05.

Mean age was 43.08 years in the ET group and 39.27 years in the LT group. In the unadjusted analysis, mean DMV was significantly shorter in the ET group (8.45 ± 4.09 days) compared with the LT group (13.73 ± 4.47 days; p<0.05). ICU stay was significantly shorter in the ET group (11.93 ± 5.24 days) than in the LT group (19.00 ± 7.02 days; p<0.05). VAP incidence was numerically lower in the ET group, with five patients (8.3%), than in the LT group, with 12 patients (20.0%), although this difference was not statistically significant. Clinical improvement was significantly higher in the ET group, with 49 patients (81.7%), compared with the LT group, with 27 patients (45.0%). The ET group had higher day 1 and day 3 GCS values than the LT group, indicating baseline neurological imbalance between groups.

In this retrospective, unadjusted cohort, ET in patients with severe TBI was associated with shorter duration of MV, reduced ICU stay, earlier ward transfer, and better short-term clinical outcomes compared with LT. These findings should be interpreted cautiously because the groups were not fully comparable in neurological severity, no prospective sample size calculation was performed, and multivariable adjustment for confounding was not possible. The results represent associations rather than evidence that ET independently caused improved outcomes.