Optimal timing of tracheostomy after @entity130 without associated XXXX .

@entity1 @entity542 @entity1514 @entity772 @entity1576 @entity130
BACKGROUND: Controversy exists over optimal timing of tracheostomy in @entity1 with @entity1576 after @entity130 . The study aimed to determine whether the timing of tracheostomy affects mortality in this population. METHODS: The 2008-2011 National Trauma Data Bank was queried to identify @entity130 @entity1 without concomitant @entity542 who required tracheostomy for @entity1576 between hospital days 4 and 21. Restricted cubic spline analysis was performed to evaluate the relationship between tracheostomy timing and the odds of inhospital mortality. The cohort was stratified based on this analysis. Unadjusted characteristics and outcomes were compared. Multivariable logistic regression was used to evaluate the effect of tracheostomy timing on mortality after adjustment for age, gender, race, payor status, level of @entity130 center, injury severity score, presentation @entity772 scale, and @entity1514 and abdominal abbreviated injury score. RESULTS: There were 9662 @entity1 included in the study. Restricted cubic spline analysis demonstrated a nonlinear relationship between timing of tracheostomy and mortality, with higher odds of mortality occurring with tracheostomy placement within 10  d of admission compared with later time points. The cohort was therefore stratified into early and delayed tracheostomy groups relative to this time point. The resulting groups contained 5402 (55.9%) and 4260 (44.1%) @entity1 , respectively. After multivariable adjustment, the delayed tracheostomy group continued to have significantly reduced odds of mortality (Adjusted odds ratio, 0.82, 95% confidence interval, 0.71-0.95, C-statistic, 0.700). CONCLUSIONS: Among non-head injured @entity130 @entity1 with prolonged @entity1576 , tracheostomy placement within 10  d of admission may result in increased mortality compared with later time points.
