دورية أكاديمية
Survival After Declining Pediatric Tracheostomy Placement.
| العنوان: | Survival After Declining Pediatric Tracheostomy Placement. |
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| المؤلفون: | Liu P; Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Brooks RL; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Bailey CH; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Whitney C; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Sewell A; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Brown AF; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Kou YF; Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Johnson RF; Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA., Chorney SR; Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, USA. |
| المصدر: | The Laryngoscope [Laryngoscope] 2023 Dec; Vol. 133 (12), pp. 3602-3607. Date of Electronic Publication: 2023 Apr 25. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8607378 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-4995 (Electronic) Linking ISSN: 0023852X NLM ISO Abbreviation: Laryngoscope Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2009- >: Philadelphia, PA : Wiley-Blackwell Original Publication: St. Louis, Mo. : [s.n., 1896- |
| مواضيع طبية MeSH: | Tracheostomy* , Sepsis*, Child ; Humans ; Retrospective Studies ; Critical Illness ; Hospitalization |
| مستخلص: | Objective: To determine survival among critically ill children when caregivers decline tracheostomy placement. Study Design: Retrospective cohort. Methods: All children (<18 years) obtaining a pre-tracheostomy consultation at a tertiary children's hospital between 2016 and 2021 were included. Comorbidities and mortality were compared between children of caregivers that declined or agreed to tracheostomy. Results: Tracheostomy was declined for 58 children but was placed for 203 children. After consultation, mortality was 52% (30/58) when declining and 21% (42/230) when agreeing to tracheostomy (p < 0.001) at a mean of 10.7 months (standard deviation [SD]: 16) and 18.1 months (SD: 17.1), respectively (p = 0.07). For those declining, 31% (18/58) died during the hospitalization within a mean of 1.2 months (SD: 1.4) while 21% (12/58) died at a mean of 23.6 months (SD: 17.5) after discharge. Among children of caregivers declining tracheostomy, older age (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p = 0.01) and chronic lung disease (OR: 0.18, 95% CI: 0.04-0.82, P = .03) were associated with lower odds of mortality but sepsis (OR: 9.62, 95% CI: 1.161-57.43, p = 0.01) and intubation (OR: 4.98, 95% CI: 1.24-20.08, p = 0.02) were associated with higher odds of mortality. Median survival after declining tracheostomy was 31.9 months (interquartile range [IQR]: 2.0-50.7) and declining placement was associated with increased mortality risk (hazard ratio [HR]: 4.04, 95% CI: 2.49-6.55, p < 0.001). Conclusion: When caregivers declined tracheostomy placement, less than half of critically ill children in this cohort survived with younger age, sepsis, and intubation associated with higher mortality. This information offers valuable insight for families weighing decisions pertaining to pediatric tracheostomy placement. Level of Evidence: 3 Laryngoscope, 133:3602-3607, 2023. (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.) |
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| فهرسة مساهمة: | Keywords: declining tracheostomy; mortality; palliative care; pediatric tracheostomy |
| تواريخ الأحداث: | Date Created: 20230425 Date Completed: 20231115 Latest Revision: 20240202 |
| رمز التحديث: | 20240205 |
| DOI: | 10.1002/lary.30712 |
| PMID: | 37096735 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1531-4995 |
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| DOI: | 10.1002/lary.30712 |