Early Tracheostomy Cut Pneumonia Risk in Head Injury

Major Finding: Patients who sustained severe, blunt head trauma and underwent tracheostomy more than 7 days following hospitalization had a significant, 88% increased risk for developing pneumonia, compared with patients who underwent a tracheostomy during their first week in hospital.

Data Source: National Trauma Data Bank information on 656 U.S. patients with head injuries during 2002-2006 who met the study's inclusion criteria.

Disclosures: Dr. Ahmed and his associates reported no disclosures.

LAS VEGAS — Patients who sustained severe, blunt head injury and underwent tracheostomy more than a week after their hospital admission had nearly twice the risk of developing pneumonia later, compared with those whose tracheostomy was performed during their first week in the hospital.

“Early tracheostomy reduced the incidence of pneumonia following severe head injury,” concluded Dr. Nasim Ahmed and his associates, whose database analysis included more than 600 patients.

The finding complements previous reports that early tracheostomy in patients with severe head injury reduced time spent in intensive care and the need for ventilator support. But prior analyses produced conflicting findings on the impact of early tracheostomy on pneumonia incidence in these patients, said Dr. Ahmed during a poster presentation at the annual meeting of the Surgical Infection Society.

Dr. Ahmed, a critical care surgeon at Jersey Shore University Medical Center, Neptune, N.J., and his associates used data collected during 2002-2006 for 656 traumatic brain injury patients in the National Trauma Data Bank.

The patients' mean age was about 40 years (range 18-89 years). One-quarter of them were women, two-thirds were white, and 12% were African American.

All patients had sustained blunt cerebral contusion injuries in street and highway accidents. Their mean Injury Severity Score was 32, their mean Glasgow Coma Scale score was about 6, and their head Abbreviated Injury Scale score was at least 3. All patients survived for at least 48 hours after hospital admission, and all underwent tracheostomy.

Pneumonia developed in 155 patients (24%). Univariate analyses of age, gender, race, Injury Severity Score, or total Glasgow Coma Scale score showed no significant differences between patients who developed pneumonia and those who did not.

A total of 90% of patients without pneumonia were discharged from the hospital, compared with 93% of patients who developed pneumonia, a nonsignificant difference.

The researchers found that the average time to tracheostomy was the only factor that significantly distinguished the two subgroups.

Patients who did not develop pneumonia had their tracheostomy an average of 9 days after hospital admission, whereas in patients who developed pneumonia, tracheostomy was performed an average of 11 days after admission, according to the study findings.

A multivariate logistic regression analysis that controlled for baseline differences revealed that tracheostomy performed more than 7 days after hospitalization was linked to a significant 88% increased risk of pneumonia, the investigators reported.