WIP 42 - Timing Might Impact Outcomes After All: Pediatric Tracheostomy Placement, A Retrospective Review

Publication Number: WIP 42.7363

Ariel Martin, University of Florida College of Medicine, Jacksonville, FL, United States; Christopher L. Carroll, Wolfson Children's Hospital, Jacksonville, FL, United States; Matthew D. Garber, UF COM-Jacksonville, Jacksonville, FL, United States; Margaret J. Klein, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Tracheostomy placement in pediatric patients is becoming increasingly common in Pediatric Intensive Care Units (PICUs) across the country . In adults, early tracheostomy placement ( < 14 days) in ventilated patients has been shown to lead to fewer complications, shorter ICU stay and shorter duration of mechanical ventilation (MV). Pediatric data have been less robust and thus insufficient to guide clinical practice. We endeavor to use the Virtual Pediatric Systems (VPS) database to determine risk factors for receiving a tracheostomy and outcomes stratified by timing of the tracheostomy, as well as to describe current trends and outcomes of pediatric patients receiving tracheostomies.

Objective: This study will attempt to identify factors associated with tracheostomy receipt as well as work to evaluate the impact of time to tracheostomy (TTT) on hospital length of stay (LOS), PICU LOS, mortality, quality outcomes, and changes in performance scores.

Design/Methods: This study met criteria for nonhuman research and was exempt from full IRB approval by UF COM . The VPS database was queried from 2017-2023 for patients intubated ≥7 days without prior tracheostomy or congenital heart disease.
Our first aim is to examine risk factors associated with receipt of tracheostomy, including age, sex, diagnosis, severity score, and PICU LOS which will be assessed using Chi-square tests, T-tests, or Mann-Whitney U tests. Variables with p< 0.10 will be entered into a multivariable logistic regression. Next, in children who received tracheostomies the effect of TTT on hospital LOS, quality outcomes, and performance score changes will be analyzed using multivariable models. Finally, we will perform a survival analysis using TTT as the outcome utilizing a Cox proportional hazards model to explore risk factors affecting TTT.
Data have been received from VPS and are currently being analyzed. Plan to complete the analysis by January 2025 and be working toward manuscript and poster submissions by April 2025.