Abstract
Background
Patients with cervical spinal cord injury (CSCI) often require tracheostomy due to a prolonged ventilator dependence. However, optimal time for tracheostomy remains controversial.
Methods
All adult patients (≥18 years) with CSCI who underwent tracheostomy were identified in the 2018-2021 Trauma Quality Improvement Program database. The median time to tracheostomy of the entire sample was found in which patients were categorized into Early (≤10 days) and Delayed (>10 days) cohorts based on whether they were below or above the median. Multivariable regression models were developed to examine the association between tracheostomy timing and clinical outcomes including pneumonia, unplanned intubation, decubitus ulcer, deep vein thrombosis, and in-hospital mortality.
Results
Of 3545 patients, 43.0% underwent tracheostomy within 10 days of admission. Compared to Delayed, Early was more commonly younger (51 [32-65] vs 58 years [40-77]; P < 0.001) and privately insured (38.6 vs 37.8%, P < 0.001). Upon adjustment, severe facial injury and a greater injury severity score (ISS) were associated with increased odds of early tracheostomy. Additionally, early tracheostomy was linked with reduced odds of pneumonia (Adjusted Odds Ratio [AOR] 0.70, 95% 0.62-0.82), decubitus ulcer (AOR 0.61, 95% CI 0.53-0.71), and unplanned intubation (AOR 0.43, 95% CI 0.37-0.49). Tracheostomy timing did not alter risk of in-hospital mortality (Early: AOR 1.08, 95% CI 0.86-1.35).
Discussion
Early tracheostomy in CSCI patients was associated with lower risk of complications, without differences in adjusted mortality rate. These findings suggest that early tracheostomy may improve acute outcomes in CSCI patients. Further prospective research is warranted to inform standardized care pathways.
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