A new nomogram to predict the need for tracheostomy in burned patients.

Abstract

PURPOSE:

To evaluate the impact of tracheostomy on complications, dysphagia and outcome in second and third degree burned patients.

METHODS:

Inpatient mortality, dysphagia, severity of burn injury (ABSI, TBSA) and complications in tracheotomized burn patients were compared to (I) non-tracheotomized burn patients and (II) matched tracheotomized non-burn patients.

RESULTS:

134 (30.9%) out of 433 patients who underwent tracheostomy, had a significantly higher percentage of inhalation injury (26.1% vs. 7.0%; p < 0.001), higher ABSI (8.9 ± 2.1 vs. 6.0 ± 2.7; p < 0.001) and TBSA score (41.4 ± 19.7% vs. 18.6 ± 18.8%; p < 0.001) compared to 299 non-tracheotomized burn patients. However, complications occurred equally in tracheotomized burn patients and matched controls and tracheostomy was neither linked to dysphagia nor to inpatient mortality at multivariate analysis. In particular, dysphagia occurred in 6.2% of cases and was significantly linked to length of ICU stay (OR 6.2; p = 0.021), preexisting neurocognitive impairments (OR 5.2; p = 0.001) and patients' age (OR 3.4; p = 0.046). A nomogram was calculated based on age, TBSA and inhalation injury predicting the need for a tracheostomy in severely burned patients.

CONCLUSION:

Using the new nomogram we were able to predict with significantly higher accuracy the need for tracheostomy in severely burned patients. Moreover, tracheostomy is safe and is not associated with higher incidenc of complications, dysphagia or worse outcome.

• Authors: Stefan Janik, Stefan Grasl, Erdem Yildiz, Gerold Besser, Jonathan Kliman, Philipp Hacker, Florian Frommlet, Alexandra Fochtmann-Frana, Boban M Erovic
• Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 278 Issue 9 Pg. 3479-3488 (Sep 2021) ISSN: 1434-4726 [Electronic] Germany
• PMID: 33346855 (Publication Type: Journal Article)
• Copyright: © 2020. The Author(s).

Topics

• Burns (complications)
• Humans
• Length of Stay
• Multivariate Analysis
• Nomograms
• Retrospective Studies
• Tracheostomy