Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Department of Pharmacology, University of Texas Medical Branch, Galveston, TX, USA.
Burns. 2023 Mar;49(2):408-414. doi: 10.1016/j.burns.2022.04.015. Epub 2022 Apr 22.
Previous analyses of tracheostomy in paediatric burns was hindered by a lack of multi-institution or nationwide analysis. This study aims to explore the effects of tracheostomy in paediatric burn patients in such an analysis. De-identified data was obtained from the TriNetX Research Network database.
Two cohorts were identified using ICD and CPT codes: paediatric burn patients with tracheostomy (cohort 1) and paediatric burn patients without tracheostomy (cohort 2). Cohorts were matched according to age at diagnosis and pulmonary condition, specifically influenza and pneumonia, respiratory failure, acute upper respiratory infection, and pulmonary collapse. Cohorts were also matched for age at burn diagnosis and surface area burned. Several parameters including infection following a procedure, sepsis, volume depletion, respiratory disorders, laryngeal disorders, pneumonia, and other metrics were also compared.
A total of 152 patients were matched according to age and pulmonary condition. Cohort 1 and cohort 2 had a mean age of 4.45 ± 4.06 and 4.39 ± 3.99 years, respectively. Matched patients with tracheostomy had a higher risk for pneumonia, respiratory failure, other respiratory disorders, diseases of the vocal cord and larynx, sepsis, volume depletion, pulmonary edema, and respiratory arrest. The risk ratios for these outcomes were 2.96, 3.5, 3.13, 3.9, 2.5, 2.5, 3.3, and not applicable. Analysis of longitudinal outcomes of paediatric burn patients with tracheostomy vs. those without demonstrated the tracheostomy cohort suffered much worse morbidity and experienced higher health burden across several metrics.
The potential benefits of tracheostomy in paediatric burn patients should be weighed against these outcomes.
之前对小儿烧伤患者行气管切开术的分析受到缺乏多机构或全国性分析的限制。本研究旨在探讨这种分析中小儿烧伤患者行气管切开术的效果。从 TriNetX 研究网络数据库中获取了去识别数据。
使用 ICD 和 CPT 代码确定了两个队列：行气管切开术的小儿烧伤患者（队列 1）和未行气管切开术的小儿烧伤患者（队列 2）。根据诊断时的年龄和肺部状况，特别是流感和肺炎、呼吸衰竭、急性上呼吸道感染和肺塌陷，对队列进行匹配。还根据烧伤诊断时的年龄和烧伤面积进行了匹配。还比较了几种参数，包括手术后感染、败血症、血容量不足、呼吸障碍、喉障碍、肺炎和其他指标。
根据年龄和肺部状况共匹配了 152 例患者。队列 1 和队列 2 的平均年龄分别为 4.45 ± 4.06 岁和 4.39 ± 3.99 岁。行气管切开术的匹配患者患肺炎、呼吸衰竭、其他呼吸障碍、声带和喉疾病、败血症、血容量不足、肺水肿和呼吸停止的风险更高。这些结果的风险比分别为 2.96、3.5、3.13、3.9、2.5、2.5、3.3 和不适用。对有气管切开术和无气管切开术的小儿烧伤患者的纵向结局进行分析表明，气管切开术组的发病率更高，在多个指标上的健康负担更重。
应权衡小儿烧伤患者行气管切开术的潜在益处和这些结果。
