Neuroanaesthesia & neurocritical care
Hospital-Level Variation in Early Tracheostomy and Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Nationwide Analysis
Main finding · WLST post-tracheostomyResult — go to the resultAdjusted odds ratio 1.35 95% CI 1.10–1.66Authors' conclusion
Hospitals with a higher tendency to perform ET had a greater likelihood of WLST following tracheostomy.
Study context
- Population
- Adults 20–89 years with severe traumatic brain injury (TBI) (head AIS 3–5, GCS 3–8), mechanically ventilated, who underwent tracheostomy; American College of Surgeons Trauma Quality Improvement Program centers (2016–2021)
- Participants
- 22,156 adults · 417 hospitals
- Exposure
- High vs low hospital-level tendency for early tracheostomy
- Outcome
- WLST post-tracheostomy
Methodological detailsmulticentre registry, mixed-effects logistic regression, multilevel case-mix adjustment
- Multicentre registry
- Mixed-effects logistic regression
- Multilevel case-mix adjustment
Main finding
As reported in the abstract
Adjusted odds ratio
1.35
95% CI 1.10–1.66
P = 0.004
High-tendency vs Low-tendency
AOR 1.35 (95% CI 1.10–1.66); P = 0.004
Observational data: associations, not effects.
Further findings
ET rate by hospital tendency
| Outcome | AOR (95% CI) | |
|---|---|---|
| WLST post-tracheostomy, age 40-59 years (subgroup)High-tendency vs Low-tendency · highest point estimate among age groups | 1.39 (1.01–1.91) | |
| 0.512Adjusted odds ratio (log scale) |
Withdrawal of life-sustaining treatment (WLST) post-tracheostomy by age (subgroup)
- Age 20-39 years
- 2.6%
- Age 40-59 years
- 4.8%
- Age 60-89 years
- 9.6%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Hospital-Level Variation in Early Tracheostomy and Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Nationwide Analysis. Crit Care Med. Published 9 June 2026. doi:10.
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