Objective indications for early tracheostomy after blunt head trauma.

BACKGROUND: Early tracheostomy has been shown to be beneficial after trauma; however, there are few objective data to identify early in the recovery period which patients will ultimately require tracheostomy after blunt head trauma.

METHODS: The charts of all patients admitted to the surgical intensive care unit intubated at a level 1 urban trauma center, over a 5-year period with a primary admission diagnosis of blunt head trauma were retrospectively reviewed.

RESULTS: Sixty-four patients met inclusion and exclusion criteria and were divided into two groups: those extubated and those that required tracheostomy. By day 3 the Glasgow Coma Scores for the two groups were significantly different and on day 4 the Simplified Acute Physiology (SAPS) Scores were significantly different.

CONCLUSIONS: Calculating objective scores such as GCS and SAPS can aid in identifying those patients who will ultimately require a tracheostomy for prolonged airway protection after blunt head trauma with high positive predictive value.