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Patient characteristics associated with in-hospital mortality in children following tracheotomy
  1. Jay G Berry1,2,
  2. Robert J Graham3,
  3. David W Roberson2,4,
  4. Lawrence Rhein5,
  5. Dionne A Graham6,
  6. Jing Zhou6,
  7. Jane O'Brien1,
  8. Heather Putney7,
  9. Donald A Goldmann8,9
  1. 1Complex Care Service, Division of General Pediatrics, Children's Hospital, Boston, Massachusetts, USA
  2. 2Program for Patient Safety and Quality, Children's Hospital, Boston, Massachusetts, USA
  3. 3Division of Critical Care Medicine, Children's Hospital, Boston, Massachusetts, USA
  4. 4Department of Otolaryngology and Communication Enhancement, Children's Hospital, Boston, Massachusetts, USA
  5. 5Division of Newborn Medicine and Division of Respiratory Diseases, Children's Hospital, Boston, Massachusetts, USA
  6. 6Clinical Research Program, Children's Hospital, Boston, Massachusetts, USA
  7. 7Institute for Community Inclusion, Boston, Massachusetts, USA
  8. 8Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  9. 9Division of Infectious Diseases and Pediatric Health Services Research, Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Jay G Berry, Complex Care Service, Children's Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA 02115, USA; jay.berry{at}childrens.harvard.edu

Abstract

Objectives To identify children at risk for in-hospital mortality following tracheotomy.

Design Retrospective cohort study.

Setting 25 746 876 US hospitalisations for children within the Kids' Inpatient Database 1997, 2000, 2003 and 2006.

Participants 18 806 hospitalisations of children ages 0–18 years undergoing tracheotomy, identified from ICD-9-CM tracheotomy procedure codes.

Main outcome measure Mortality during the initial hospitalisation when tracheotomy was performed in relation to patient demographic and clinical characteristics (neuromuscular impairment (NI), chronic lung disease, upper airway anomaly, prematurity, congenital heart disease, upper airway infection and trauma) identified with ICD-9-CM codes.

Results Between 1997 and 2006, mortality following tracheotomy ranged from 7.7% to 8.5%. In each year, higher mortality was observed in children undergoing tracheotomy who were aged <1 year compared with children aged 1–4 years (mortality range: 10.2–13.1% vs 1.1–4.2%); in children with congenital heart disease, compared with children without congenital heart disease (13.1–18.7% vs 6.2–7.1%) and in children with prematurity, compared with children who were not premature (13.0–19.4% vs 6.8–7.3%). Lower mortality was observed in children with an upper airway anomaly compared with children without an upper airway anomaly (1.5–5.1% vs 9.1–10.3%). In 2006, the highest mortality (40.0%) was observed in premature children with NI and congenital heart disease, who did not have an upper airway anomaly.

Conclusions Congenital heart disease, prematurity, the absence of an upper airway anomaly and age <1 year were characteristics associated with higher mortality in children following tracheotomy. These findings may assist provider communication with children and families regarding early prognosis following tracheotomy.

  • Accepted 26 March 2010

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  • Accepted 26 March 2010
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Footnotes

  • Funding NIH

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Children's Hospital, Boston. This research was approved by the institutional review board (IRB No M08-10-0467).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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