OBJECTIVE: To investigate the association between community socioeconomic distress and timing of speaking valve (SV) assessment among children who underwent tracheostomy placement. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care children's hospital. METHODS: Children who underwent tracheostomy between 2016 and 2022 were included. Associations between the Distress Community Index (DCI) and time to SV assessment were evaluated using regression models adjusted for covariates and stratified by intensive care unit (ICU) type. RESULTS: A total of 147 patients with a mean age at tracheostomy of 4.5 years were included. The cohort was 83.0% white, 11.6% black, and 5.4% Other. DCI breakdown was 19.7% Distressed, 25.2% At Risk, 23.8% Mid-Tier, 18.4% Comfortable, and 12.9% Prosperous. Overall, 71.4% of patients completed the SV assessment. Community distress was not associated with completion of the SV assessment. Higher community distress and younger age at tracheostomy were associated with longer time to SV assessment (P < .001 and P = .003, respectively), with trends in community distress consistent across all ICU types. Patients in the pediatric intensive care unit (PICU) received SV assessments sooner than patients in the neonatal intensive care unit (NICU) (median 18 vs 121 days, P < .001). Stratifying by DCI quintiles, patients from Prosperous communities were 2.41 times more likely to receive a timely SV assessment compared to patients from Distressed communities (hazard ratio HR = 2.41, P < .001). CONCLUSION: Higher community distress, younger age at tracheostomy, and stay in the NICU were associated with longer delays in SV assessment. Standardized protocols and support systems are needed to ensure timely SV assessments and thus optimal physiologic, cognitive, and social development for all children with tracheostomy.
Harris et al. (Tue,) studied this question.