Background: Studies have shown that the early tracheostomy decreases the Ventilator and intensive care days. However, there are conflicting reports whether there is any impact of early tracheostomy in the incidence of pneumonia following severe head injury. The purpose of this study was to see any association of timing of tracheostomy in the incidence of pneumonia following severe head injury patients.

Methods: Patient information was retrieved from the National Trauma Data Bank Research Data Set v7.1. The inclusion criteria were: Blunt cerebral contusion injury at street and highway. Sever head injury was identified via the Abbreviated Injury Scale (AIS) codes with the AIS score ≥3, age between 18 and 89 years, and survived for 48 hours and underwent tracheostomy. Pneumonia during the course of treatment was the primary outcome. Wilcoxon rank-sum test and chi-square test was used to compare the continuous variables. Multiple logistic regression models were used to assess the association between the timing of the tracheostomy and pneumonia while controlling for potential confounding factors.

Results: Data from 656 TBI patients admitted during 2002-2006 were evaluated. The overall incidence rate of pneumonia was 23.6%. Patients who had developed pneumonia were similar to those who did not develop pneumonia in terms of age (mean[SD]: 39.7[17.2] vs. 39.3[17.2] years, P=0.73), female gender (22.6% vs. 29.5%, P=0.09), Injury Severity Score (ISS) (32.3[11.0] vs. 32.7[12.5], P=0.94) and initial Glasgow Coma Scale (6.1[4.1] vs. 6.1[4.4], P=0.67). However, patients who had developed pneumoina, had a significantly delayed timing of tracheostomy (11.0[7.1] vs. 9.3[7.0] days, P=0.0006). From a multivariate logistic regression model, late tracheostomy (> 7 days) had a higher chance of developing pneumonia (odds ratio=1.88, 95% confidence interval: [1.19, 2.95], P=0.006).

Conclusion: Early tracheostomy reduces the incidence of pneumonia following severe head injury.

Pneumonia: 23.6% (155/656)