Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
J Neurosurg. 2011 Nov;115(5):1007-12. doi: 10.3171/2011.7.JNS101829. Epub 2011 Aug 5.
Patients with severe traumatic brain injury (TBI) frequently require a tracheostomy for prolonged mechanical ventilation and/or pulmonary toilet. It is now proven that the earlier the procedure is done, the more beneficial it is to the patient. The present study was carried out to determine if the requirement of a tracheostomy can be predicted on arrival of a patient to the emergency department. The prediction can potentially aid in combining the procedure with cranial decompression. In this study, the authors' aim was to determine the emergency department predictors of tracheostomy in patients with isolated TBI requiring emergency cranial decompression.
The authors performed a retrospective chart review of all patients who underwent surgery for isolated TBI and required more than 4 days of mechanical ventilation. Multivariate logistic regression analysis was used for predictive indicators.
In patients with isolated severe TBI, a patient age of 31-50 years, the presence of preexisting medical comorbid conditions, a delay in emergency department arrival exceeding 1.5 hours, an abnormal pupil response on arrival, and a preoperative neurological worsening during hospital stay were independent predictors of the requirement for tracheostomy. These findings were validated in a small cohort of patients and were found to be significant.
Requirement of a tracheostomy can be predicted in patients with severe TBI on arrival to the emergency department. These results were validated in a small cohort of patients, and it was found that the positive predictive value of requirement of tracheostomy was directly proportional to the number of predictors present. Larger prospective studies with appropriate control groups are further recommended to validate the authors' findings.
严重创伤性脑损伤（TBI）患者常需要行气管切开术以进行长时间机械通气和/或肺部清洁。目前已证实，手术越早进行，对患者越有益。本研究旨在确定患者到达急诊科时是否可以预测是否需要行气管切开术，这可能有助于将该手术与颅骨减压术结合进行。在本研究中，作者的目的是确定需要行紧急颅骨减压术的单纯 TBI 患者在急诊科行气管切开术的预测因素。
作者对所有因单纯 TBI 而行手术且需要机械通气超过 4 天的患者进行了回顾性图表审查。采用多变量逻辑回归分析预测指标。
在单纯严重 TBI 患者中，年龄为 31-50 岁、存在预先存在的合并症、急诊科到达时间延迟超过 1.5 小时、到达时瞳孔反应异常以及住院期间术前神经恶化是需要行气管切开术的独立预测因素。在一小部分患者中验证了这些发现，结果具有统计学意义。
在到达急诊科的严重 TBI 患者中可以预测是否需要行气管切开术。这些结果在一小部分患者中得到了验证，并且发现需要行气管切开术的阳性预测值与存在的预测因素数量成正比。建议进一步开展更大规模的前瞻性研究，纳入适当的对照组以验证作者的发现。
