Ideal Timing for Tracheostomy in Pediatric Patients With Severe Traumatic Brain Injury: Systematic Review and Meta-analysis

Abstract Purpose: We conducted a systematic review with meta-analysis to evaluate the effects of early tracheostomy (ET) versus late tracheostomy (LT) in pediatric patients with severe traumatic brain injury (sTBI). Methods: A systematic search was performed in the PubMed, Embase, and Web of Science databases. ET was defined as tracheostomy performed within 10 days, while sTBI was characterized by Abbreviated Injury Scale (AIS) scores greater than 2, Glasgow Coma Scale scores lower than 8 and Composite Stroke Severity Scale (CSSS) over than 1. Outcomes analyzed included hospital length of stay (HLS), intensive care unit stay, incidence of pneumonia, and mortality. Results: The initial search yielded 217 results, of which 25 were removed due to duplication and 180 were excluded based on title/abstract screening. Of the remaining 12 studies, 8 did not adequately address the topic, resulting in the inclusion of 3 retrospective cohort studies in the final review. A total of 2,518 pediatric patients with sTBI were analyzed. ET was performed in 1,025 (40.7%) participants, with a median age of 16.03 years (IQR: 4–18). The incidence of pneumonia (RR: 0.73; 95% CI: 0.66 to 0.81; p < 0.00001) and HLS (MD: -14.3; 95% CI: -24.29 to -4.31; p = 0.005) were significantly lower in the ET group. Other outcomes were not consistently reported. Conclusion: Tracheostomy performed within 10 days is associated with a reduced incidence of pneumonia and shorter hospital stay in pediatric patients with sTBI.