Author(s)
Clarice Brown, MD
Jenna Wiles, BS
Cynthia Wang, MD
Gopi B. Shah, MD MPH
Ron B. Mitchell, MD
Romaine F. Johnson, MD MPH
Affiliation(s)
UT Southwestern Medical Center;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss racial and ethnic disparities in the long term outcomes of children with tracheostomies. Objectives: 1) Compare the decannulation and mortality rates using the Kaplan-Meier method among a cohort of children; (2) analyze outcomes by race and ethnicity to assess for disparities; and (3) determine levels of neurocognitive disability among survivors at the time of censoring (decannulation or current status). Study Design: Retrospective case series. Methods: We queried a tracheostomy registry of patients entered between 2014 to 2019. Patients are automatically entered into the registry at the time of tracheostomy or the first visit to the institution if tracheostomy was performed elsewhere or before the implementation of the registry in 2014. Primary outcomes (death or decannulation) were analyzed for racial and ethnic groups by the Kaplan-Meier method. Censoring occurred if the patient aged out (> 21 years old) or was lost to followup (no visits in 36 months). Statistical significance was set at p<=.005. Results: The study included 445 patients with a median (IQR) age at tracheostomy placement of 0.5 (0.1) years. The population was 54% male. The racial composition was: 32% Hispanic, 31% White, 30% Black, 4.3% Other, 2.9% Asian. The median time to decannulation was 2.3 years (95% CI, 2.0 to 2.7 years). The 5 year decannulation rate was 49% (95% CI 40% to 57%) The median time to death was 6.9 months (95% CI 4.8 months to 1.3 years) and the 5 year survival rate after tracheostomy was 77% (95% CI, 69% to 83%). The log rank test showed no significant differences among racial groups for decannulation (P = .168) or death (P = .920). Additional investigation with the Cox proportional hazard regression showed that decannulation and death probabilities were equal after controlling for age, sex, prematurity, and ventilation dependence. The neurocognitive disability was deemed normal in 39 (12%), moderate, n=138 (44%), and severe in 137 (44%) among the survivors with no racial differences (P = .921). Conclusions: Among a cohort of pediatric tracheostomy patients, the decannulation and mortality rates were similar across racial and ethnic groups. Also, the neurocognitive disability was moderate to severe among most of the survivors.