.jpg "Priyanka Mehrotra photo")
Priyanka Mehrotra
New York-Presbyterian Hospital/Weill Cornell Medical Center
New York, NY
Disclosure information not submitted.
Charlene Thomas, MS
Research Biostatistician
Weill Cornell Medical College, United States
Disclosure information not submitted.
Sarah Finn, MHA
Data Analyst
New York-Presbyterian Hospital/Morgan Stanley Children's Hospital, United States
Disclosure information not submitted.
Linda Gerber, PhD
Director of the Biostatistics and Research Methodology Core and Professor of Public Health
Weil Cornell Medical College, United States
Disclosure information not submitted.
Alison Maresh, MD
Assistant Professor of Otolaryngology
New York-Presbyterian Hospital/Weill Cornell Medical Center, United States
Disclosure information not submitted.
Marianne Nellis, MD, MS
Pediatric Intensivist
New York-Presbyterian Hospital/Weill Cornell Medical College
New York, NY
Disclosure information not submitted.
Title: Timing of Tracheostomy in Critically Ill Infants and Children with Respiratory Failure: A PHIS Study
Introduction: Tracheostomy placement in children has steadily increased in the past decade, yet there is no consensus for optimal timing. We sought (1) to describe the timing of tracheostomy and associated demographic and clinical characteristics in a large pediatric intensive care unit (ICU) cohort and (2) to compare the clinical outcomes between subgroups based on timing of tracheostomy.
Methods: We conducted a retrospective observational study using the Pediatric Health Information System (PHIS). PHIS was queried for all patients who underwent tracheostomy from 2010 to 2020. Patients were included if <18 years, admitted to the ICU from 2010-2020, with documented need for mechanical ventilation (MV) prior to tracheostomy. Patients were separated into early - ET (defined as placement at < 14 days from start of MV), late - LT (placement 14-60 days from start of MV), and prolonged - PT (placement >60 days from start of MV). Primary endpoints included description of demographic and clinical characteristics. Secondary endpoints included patient outcomes including length of stay (LOS), hospital cost, and mortality.
Results: 3119 patients underwent tracheostomy at 51 children’s hospitals. 45% (1396/3119) underwent ET, 37% (1163/3119) underwent LT and 18% (560/3119) underwent PT. The median (IQR) age (in months) for the total cohort was 5 (1-49) and was significantly different between the three groups with ET being the oldest (p< 0.001). Significant differences were observed in race (p=0.03) and geographic region (p< 0.001). No differences in gender (p=0.30) were seen. Though the majority of children in all subgroups had complex, chronic conditions, less children who underwent ET had underlying chronic disease (p< 0.001). ET was associated with shorter LOS (both hospital and PICU) (p< 0.001), lower cost (p< 0.001), and lower mortality (p< 0.001) as compared to those children who underwent LT or PT.
Conclusions: In a large cohort of pediatric patients with respiratory failure in the US, older age and less underlying chronic disease were associated with ET. As compared with LT and PT, ET was associated with shorter LOS, lower cost, and lower mortality. Further analysis is needed to determine independent associations in an attempt to develop standardized timing of tracheostomy in subgroups of critically ill children.