Pia S Pannaraj, Hai-Lin Wang, Hector Rivas, Hilda Wiryawan, Michael Smit, Nicole Green, Grace M Aldrovandi, Alvin Nelson El Amin, Laurene Mascola
School-located influenza vaccination decreases laboratory-confirmed influenza and improves school attendance
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
traumatic brain injury tbi prevalent cause disability death pediatric population often requiring prolonged mechanical ventilation patients significant tbi intracranial hemorrhage require advanced airway management protect aspiration hypoxia hypercarbia eventually necessitating tracheostomy tracheostomy much less common children compared adults prevalence among pediatric populations steadily increasing although early tracheostomy demonstrated improved outcomes adult patients optimal tracheostomy timing pediatric population tbi remains definitively established retrospective cohort analysis aims evaluate pediatric tbi patients undergo tracheostomy investigate impact tracheostomy timing outcomes healthcare cost utilization project hcup kids inpatient database kid collected 2016 2019 queried using international classification disease 10th edition icd10 codes patients traumatic brain injury received tracheostomy baseline demographics insurance status procedural day data analyzed univariate multivariate regression analyses propensity score matching performed estimate incidence medical complications mortality related early versus late tracheostomy timing defined median 9 days 68793 patients mean age 14 iqr 418 suffered tbi 1956 28 received tracheostomy hospital stay tbi patients tracheostomized older mean age 165 vs 114 years likely injuries classified severe tbis likely accumulated one indicator parenchymal injury measured composite stroke severity scale csss 1 nontracheostomized tbi patients tbi patients tracheostomy likely encounter serious complications sepsis acute kidney injury aki meningitis acute respiratory distress syndrome ards also likely necessitate external ventricular drain evd decompressive hemicraniectomy dhc tbi patients without tracheostomy tracheostomy also negatively associated routine discharge procedural timing assessed 1867 patients older children age 15 years likely undergo earlier placements p 0001 propensity score matching psm comparing early versus late placement completed controlling age gender tbi severity subjected late tracheostomy 9 days likely face complications aki deep vein thrombosis dvt well host respiratory conditions pulmonary embolism aspiration pneumonitis pneumonia ards timing significantly impact mortality across psm cohorts late tracheostomy associated increased length stay los ventilator dependence tracheostomy necessary patients sustained tbi associated several risks assessed context individual patients overall condition additionally timing intervention may significantly impact trajectory patients recovery early intervention may reduce incidence serious complications well length stay dependence ventilator facilitate timelier recovery