J. Vanderpool1, S. Babel1, M. Inkel1,2, M. Behbahaninia1,2 1University Of South Florida College Of Medicine, Tampa, FL, USA 2Tampa General Hospital, Tampa, FL, USA
Introduction:
Traumatic brain injury (TBI) is a leading cause of mortality and long-term disability worldwide, presenting significant challenges in acute management. Clinicians face complex decisions regarding the timing and implementation of long-term ventilatory and nutritional support in TBI patients, with existing tools like the Glasgow Coma Scale (GCS) providing limited predictive accuracy. Although early intervention with percutaneous endoscopic gastrostomy (PEG) and tracheostomy is associated with improved outcomes, the optimal timing for these procedures remains uncertain.
Objective:
This study aims to identify the optimal timing for PEG and tracheostomy in TBI patients by assessing the impact of procedure timing and provider variation on patient outcomes.
Methods:
We conducted a retrospective review of 263 patients, aged 18-87, diagnosed with TBI between January 1, 2013, and December 31, 2022, at a single academic institution. All patients underwent tracheostomy and/or PEG during their hospital admission. The cohort included 194 males and 69 females, excluding those with non-surgical feeding tubes, pregnant women, incarcerated individuals, and patients under 18 years. Data were extracted from Epic Medical Records and analyzed using SPSS software.
Results:
Early intervention (within 7 days) was associated with significantly shorter hospital and ICU stays and fewer complications compared to standard (8-14 days) and delayed (15+ days) procedures. Patients receiving early PEG had a significantly lower mean hospital length of stay (36.10±33.289 days, p<0.01), ICU length of stay (12.76±7.25 days, p<0.01), and number of complications (0.76±1.35, p<0.01) than those in the standard or late groups. Similarly, early tracheostomy was linked to shorter mean hospital stays (46.49±40.783 days, p<0.01), ICU stays (13.08±6.558 days, p=0.016), fewer mean number of complications (0.80±0.944, p<0.01), and earlier decannulation (46.2407±59.196 days, p<0.01). Acute care surgery (ACS) and trauma surgery performed the majority of early PEG and tracheostomy procedures, with 71.1% in the early group, 54.7% in the standard group, and 27.3% in the late group.
Conclusion:
Early PEG and tracheostomy performed by ACS and trauma surgery providers are associated with optimized patient outcomes, including reduced hospital and ICU stays and fewer complications. These findings underscore the importance of timely interventions and coordinated care in TBI management and suggest a potential benefit in prioritizing ACS and trauma services for these patients.