Evidence map›Paper›PMID 30334232›Full record

Observational studyNeurocritical care2019

Inpatient Complications Predict Tracheostomy Better than Admission Variables After Traumatic Brain Injury.

Ryne Jenkins, Nicholas A Morris, Bryce Haac, Richard Van Besien, Deborah M Stein, Wan-Tsu Chang, Gary Schwartzbauer, Gunjan Parikh, Neeraj Badjatia

Open access · bronzeAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Ryne Jenkins *R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, Gudelsky Bldg., Room G7K18, Baltimore, MD, 21201, USA.ORCID http://orcid.org/0000-0002-5774-5826
Nicholas A Morris *Section of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Bryce HaacR. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, Gudelsky Bldg., Room G7K18, Baltimore, MD, 21201, USA.
Richard Van BesienR. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, Gudelsky Bldg., Room G7K18, Baltimore, MD, 21201, USA.
Deborah M SteinR. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, Gudelsky Bldg., Room G7K18, Baltimore, MD, 21201, USA.
Wan-Tsu ChangSection of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Gary SchwartzbauerSection of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Gunjan ParikhSection of Neurocritical Care and Emergency Neurology, Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Neeraj BadjatiaR. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, 22 S. Greene Street, Gudelsky Bldg., Room G7K18, Baltimore, MD, 21201, USA. nbadjatia@umm.edu.
University of Maryland, Baltimore · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundData regarding who will require tracheostomy are lacking which may limit investigations into therapeutic effects of early tracheostomy.

methodsWe performed an observational study of adult traumatic brain injury (TBI) patients requiring intensive care unit (ICU) admission for ≥ 72 h and mechanical ventilation for ≥ 24 h between January 2014 and December 2014 at a level 1 trauma center. Patients who had life-sustaining measures withdrawn were excluded. Multivariable logistic regression analyses were used to assess admission and inpatient factors associated with receiving a tracheostomy and to develop predictive models. Inpatient complications prior to day 7 were used to standardize data collection for patients with and without tracheostomy. Patients who received tracheostomy prior to day 7 were excluded from analysis.

resultsIn total, 209 patients (78% men, mean 48 years old, median Glasgow Coma Scale score (GCS) 8) met study criteria with tracheostomy performed in 94 (45%). Admission predictors of tracheostomy included GCS, chest tube, Injury Severity Score, and Marshall score. Inpatient factors associated with tracheostomy included the requirement for an external ventricular drain (EVD), number of operations, inpatient dialysis, aspiration, GCS on day 5, and reintubation. Multiple logistic regression analysis demonstrated that the number of operation room trips (adjusted odds ratio [AOR], 1.75; 95% CI, 1.04-2.97; P = 0.036), reintubation (AOR, 8.45; 95% CI, 1.91-37.44; P = .005), and placement of an EVD (AOR, 3.48; 95% CI, 1.27-9.58; P = .016) were independently associated with patients undergoing tracheostomy. Higher GCS on hospital day 5 (AOR, 0.52; 95% CI, 0.40-0.68; P < 0.001) was protective against tracheostomy. A model of inpatient variables only had a stronger association with tracheostomy than one with admission variables only (ROC AUC 0.93 vs 0.72, P < 0.001) and did not benefit from the addition of admission variables (ROC AUC 0.93 vs 0.92, P = 0.78).

conclusionPotentially modifiable inpatient factors have a stronger association with tracheostomy than do admission characteristics. Multicenter studies are needed to validate the results.

Indexed as

Brain Injuries, TraumaticAdultAgedCritical CareFemaleHumansMaleMiddle AgedOutcome Assessment, Health CarePatient AdmissionPrognosisRespiration, ArtificialTracheostomyHead injuryOutcomesTracheostomyTraumatic brain injury

Identifiers

PMID30334232
OpenAlexW2896609042

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.