Equipos Multidisciplinarios de Traqueostomía Reducen la Utilización de los Servicios de Urgencias en Pacientes...

To evaluate the effect of multidisciplinary tracheostomy team (MDT) interventions on emergency department utilization in pediatric patients with tracheostomy.

This retrospective cohort study analyzed a prospective registry of 364 children who underwent tracheostomy from 2015 to 2023 at a single tertiary pediatric center. The study period encompassed pre-intervention, post-intervention pre-COVID, COVID-19, and post-COVID recovery phases. Primary outcomes were time to ED visits and ED visit frequency, analyzed using parametric survival analysis and mixed-effects negative binomial regression.

Among 364 patients (mean age 3.5 ± 5.4 years; 53% male), MDT implementation was associated with a 50% reduction in ED visit rates (incidence rate ratio 0.50, 95% CI: 0.43-0.57, p < 0.001) during the post-intervention, pre-COVID period. Benefits sustained through COVID (65% reduction) and post-COVID recovery (91% reduction). Time to first ED visit increased significantly across post-intervention periods (post-intervention, pre-COVID: time ratio 1.22, 95% CI: 1.12-1.32, p < 0.001; post-COVID recovery: time ratio 1.25, 95% CI: 1.11-1.40, p < 0.001). During median follow-up of 2.8 years, 1056 of 1842 total encounters (57%) involved ED visits. Respiratory conditions accounted for 34% of ED visits. Hispanic ethnicity (time ratio 0.88, p = 0.003) and respiratory-related visits (time ratio 0.78, p < 0.001) were associated with shorter return intervals but did not affect overall visit frequency.

MDTs were associated with sustained 50% reductions in pediatric ED utilization, with reductions continuing through the COVID-19 pandemic.

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