Significant Disparities in Adolescents With Severe Traumatic Brain Injury Across Trauma Center Types: Wide Variation of Tracheostomy and Gastrostomy
Main finding · TracheostomyResult — go to the resultAdjusted incidence rate ratio 0.38 95% CI 0.28–0.52Authors' conclusion
Our results offer insights into the existing current practice variations between ATC, MTC, and PTC in tracheostomy and gastrostomy placement for adolescent with severe TBI.
Study context
- Population
- Adolescents 14–18 years old with severe traumatic brain injury (TBI) (Head Abbreviated Injury Scale 3–5, GCS 3–8) requiring mechanical ventilation, ACS Trauma Quality Improvement Program centers, 2017–2021
- Participants
- 6,978 adolescents
- Exposure
- Pediatric trauma centers (PTC) and MTC vs ATC
- Outcome
- Tracheostomy and gastrostomy rates
Methodological detailsmultilevel mixed-effect Poisson regression, multicentre registry
- Multilevel mixed-effect Poisson regression
- Multicentre registry
Main finding
Tracheostomy
Adjusted incidence rate ratio
0.38
95% CI 0.28–0.52
P < 0.001
By group
PTC vs ATC
adjusted IRR 0.38 (95% CI 0.28–0.52); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | ATC | MTC | PTC | Adjusted IRR (95% CI) | P value | |
|---|---|---|---|---|---|---|
| GastrostomyPTC vs ATC | 21.3% | 21.3% | 11.1% | 0.58 (0.44–0.75) | P < 0.001 | |
| 0.512Adjusted incidence rate ratio (log scale) |
Time to tracheostomy
Time to tracheostomy
- Significantly later timing of tracheostomy at PTC
Safety
- No significant difference in ventilator-associated pneumonia (VAP) rate between ATC, MTC and PTC
Original publication
Significant Disparities in Adolescents With Severe Traumatic Brain Injury Across Trauma Center Types: Wide Variation of Tracheostomy and Gastrostomy. Crit Care Med. Published 8 January 2025. doi:10.
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