Characterizing Mortality In Pediatric Tracheostomy Patients
Title
Characterizing Mortality In Pediatric Tracheostomy Patients
Creator
Funamura JL; Yuen S; Kawai K; Gergin O; Adil E; Rahbar R; Watters K
Identifier
DOI: 10.1002/lary.26361
Publisher
Laryngoscope
Date
2016
Subject
Pediatric Tracheostomy; Bronchopulmonary Dysplasia; Congenital Heart Disease; Tracheostomy Indication
Description
OBJECTIVES/HYPOTHESIS:
To assess the longitudinal risk of death following tracheostomy in the pediatric age group.
STUDY DESIGN:
Retrospective cohort study.
METHODS:
Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model.
RESULTS:
Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001).
CONCLUSIONS:
Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.
LEVEL OF EVIDENCE:
4 Laryngoscope, 2016.
To assess the longitudinal risk of death following tracheostomy in the pediatric age group.
STUDY DESIGN:
Retrospective cohort study.
METHODS:
Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model.
RESULTS:
Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001).
CONCLUSIONS:
Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.
LEVEL OF EVIDENCE:
4 Laryngoscope, 2016.
Rights
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Citation List Month
November 2016 List
Citation
Funamura JL; Yuen S; Kawai K; Gergin O; Adil E; Rahbar R; Watters K, “Characterizing Mortality In Pediatric Tracheostomy Patients,” Pediatric Palliative Care Library, accessed April 24, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10631.