Predicting the Need for Tracheostomy in Trauma Patients Without Severe Head Injury

BACKGROUND: Early tracheostomy is recommended in patients with severe traumatic brain injury (TBI); however, predicting the timing of tracheostomy in trauma patients without severe TBI can be challenging. METHODS: A one year retrospective analysis of all trauma patients who were admitted to intensive Care Unit for \u3e 7 days was performed, using the ACS-TQIP database. Univariate and Multivariate regression analyses were performed to assess the appropriate weight of each factor in determining the eventual need for early tracheostomy. RESULTS: A total of 21,663 trauma patients who met inclusion and exclusion criteria were identified. Overall, tracheostomy was performed in 18.3% of patients. On multivariate regression analysis age \u3e70, flail chest, major operative intervention, ventilator days \u3e5 days and underlying COPD were independently associated with need of tracheostomy. Based on these data, we developed a scoring system to predict risk for requiring tracheostomy. CONCLUSION: Age \u3e70, presence of flail chest, need for major operative intervention, ventilator days \u3e5 and underlying COPD are independent predictors of need for tracheostomy in trauma patients without severe TBI