Incidence of Pediatric to Adult Transition Among Tracheotomy Patients.

Autor: Lee R; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A., Chorney SR; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A., Kou YF; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A., Wang CS; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A., Brooks R; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A., Johnson RF; Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.; Division of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, Texas, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2024 Oct 08. Date of Electronic Publication: 2024 Oct 08.
DOI: 10.1002/lary.31826
Abstrakt: Objective: To estimate the incidence and identify predictors of pediatric tracheostomy patients who transition into adulthood with a tracheostomy.
Methods: We conducted a retrospective analysis of pediatric tracheostomy patients treated at a single tertiary care pediatric hospital between 2009 and 2022. Patient demographics, comorbidities, tracheostomy outcomes, including decannulation and mortality rates, and the status of those alive with a tracheostomy at adulthood were compared.
Results: Of the 663 children who underwent a tracheostomy, 103 (15.5%) would have surpassed 18 years by September 1, 2023. Detailed breakdown: 26 (25%) were alive with a tracheostomy, 35 (34%) had been decannulated, 25 (24%) had passed away, and 17 (16.5%) were lost to follow-up. Patients who retained their tracheostomies into adulthood were more likely to be older at tracheostomy placement (mean age 14.3 vs. 1.7 years, p < 0.001), Hispanic (43.7% vs. 30.5%, p = 0.003), not ventilated at initial discharge (41% vs. 24%, p < 0.001), and have severe neurocognitive disabilities (72% vs. 53%, p < 0.001). Logistic regression identified older age at tracheostomy placement (OR = 1.35, 95% CI [1.24-1.48]) and severe neurocognitive disability (OR = 6.20, 95% CI [2.13-18.09]) as significant predictors of maintaining a tracheostomy into adulthood.
Conclusions: Older age at tracheostomy placement and severe neurocognitive disabilities significantly predict the transition of pediatric tracheostomy patients to adult care with their tracheostomies. These findings highlight the need for specialized transition programs tailored to the needs of this unique population.
Level of Evidence: IV Laryngoscope, 2024.
(© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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