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June 9, 2026Critical Care Medicine

Hospital-Level Variation in Early Tracheostomy and Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Nationwide Analysis

Morihiro Katsura Tatsuyoshi Ikenoue Corey Ambrose Caitlyn Braschi Shingo Fukuma Kazuhide Matsushima

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Key Points

Evaluate the relationship between hospital-level tendency for early tracheostomy and frequency of withdrawal of life-sustaining treatment in severe traumatic brain injury.
Retrospective cohort study analyzing data from 22,156 patients at 417 trauma centers.
Developed a mixed-effects logistic regression model to estimate hospital-specific odds ratios for early tracheostomy.
Stratified hospitals into low-, medium-, and high-tendency groups based on early tracheostomy rates.
Early tracheostomy rates were 16.8% in low-, 30.1% in medium-, and 47.7% in high-tendency hospitals.
Withdrawal of life-sustaining treatment occurred in 2.6%, 4.8%, and 9.6% of patients aged 20-39, 40-59, and 60-89, respectively.
A high tendency for early tracheostomy was associated with increased odds of treatment withdrawal (AOR, 1.35; 95% CI, 1.10-1.66; p = 0.004).

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Implication

Retrospective cohort study assesses early tracheostomy and treatment withdrawal in severe TBI, indicating practice variability.

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Cite This Study

Katsura et al. (2026) studied this question.

synapsesocial.com/papers/6a2a512e80c8f91e7f39d886 https://doi.org/10.1097/ccm.0000000000007236

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