Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

Misaki Murasaki; Shinsuke Tanizaki; Taizo Nakanishi; Yasuo Toma; Minoru Hayashi; Kumiko Kono; Hiroshi Ishida; Shigenobu Maeda; Hideya Nagai; Hiroyuki Azuma; Ken-Ichi Kano

doi:10.1002/ams2.640

Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury

Acute Med Surg. 2021 Mar 30;8(1):e640. doi: 10.1002/ams2.640. eCollection 2021 Jan-Dec.

Affiliations

¹ Department of Emergency Medicine Fukui Prefectural Hospital Fukui City Japan.
² Department of Emergency Medicine Japanese Red Cross Fukui Hospital Fukui City Japan.
³ Department of Neurosurgery Fukui Prefectural Hospital Fukui City Japan.

Abstract

Aim: Tracheostomy is a common procedure for intubated patients with traumatic brain injury (TBI) in the intensive care unit (ICU) but optimal timing and the predictors of tracheostomy are still unclear. The aim of our study was to explore whether the traumatic variables of head injury predict the need for tracheostomy in intubated TBI patients.

Methods: A single-center, retrospective observational study including a series of TBI patients admitted to Fukui Prefectural Hospital from April 1, 2004 to March 31, 2020 was carried out. Our primary outcome was tracheostomy. Patients with TBI who were intubated and admitted into the ICU within 24 h after injury were enrolled. Exclusion criteria were age less than 18 years, pregnancy, mortality within 24 h, post-cardiac arrest syndrome, and patients for whom life-sustaining interventions were withheld. Radiologic images were also reviewed and the morphology of the head injury was categorized.

Results: Seventy-six patients were included. Forty-six patients (60.5%) underwent tracheostomy and 30 patients (39.5%) were successfully extubated. Calvarial fracture (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.13-0.88; P = 0.03), Injury Severity Score (OR 1.07; 95% CI, 1.00-1.15; P = 0.04), and Glasgow Comas Scale score (OR 0.84; 95% CI, 0.73-0.96) were statistically significant in the univariable analysis. Multivariate logistic regression identified calvarial fracture as an independent predictor for tracheostomy. The model involving calvarial fracture, Injury Severity Score ≥16, and Glasgow Coma Scale score ≤8 showed the area under the receiver operating characteristic curve for the model was 0.737 (95% CI, 0.629-0.846).

Conclusions: The absence of calvarial fracture could predict the necessity for tracheostomy in intubated TBI patients when combined with other factors. Further prospective randomized trials are necessary to confirm the findings.

Keywords: Calvarial fracture; tracheostomy; traumatic brain injury.