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Neurological Rehabilitation

A 10-year Cohort analysis of tracheostomised patients with profound brain injury presenting to a UK tertiary specialist rehabilitation unit, 2010-2020

(Research Hub Theater) A 10-year Cohort Analysis of Tracheostomised Patients with Profound Brain Injury Presenting to a UK Tertiary Specialist Rehabilitation Unit, 2010-2020

Friday, November 17, 2023
12:00 PM – 1:45 PM CT

    Primary Author(s)

  • Lynne F. Turner-Stokes, MD, Other

    Director Regional Hyperacute Rehab Unit. Northwick ParkProfessor of rehabilitation Medicine
    King's College London
    London, England, United Kingdom

    • Co-Author(s)

  • HW

    Heather Williams, Other

    Research assistant
    London North West University Healthcare NHS Trust
    Harrow, England, United Kingdom

  • Stephen Andrew Ashford, PhD

    Consultant Physiotherapist and Reader in Rehabilitation
    North West London Hospitals Nhs TrustKing's Coll London
    London, England, United Kingdom

Background and/or Objectives: Patients with profound disability following acquired brain injury (ABI) may still require a tracheostomy on entry to rehabilitation. There is little information about the impact of an ongoing requirement for tracheostomisation on outcomes and survival. To examine the characteristics and outcomes (including survival) for tracheostomised patients admitted for specialist rehabilitation

Design: A retrospective cohort analysis of prospectively collected data from the UK national clinical database.

Setting : A single UK tertiary specialist neuro-rehabilitation unit

Participants : Tracheostomised patients admitted over a 10-year period from 2010-2020 (n=250)

Interventions: Inpatient specialist rehabilitation, including tracheostomy weaning if appropriate

Main Outcome Measures: Tracheostomy weaning, Emergence into consciousness, Mortality,
Discharge destination

Results: Demographics: Mean age 44 years, Males: Females 64:36%. Mean length of stay 105 days. Aetiology: Trauma 32%, Anoxia 30%, stroke 25%, other 13%. 145/250 (58%) were successfully weaned during admission, but 105 patients (42%) could not be weaned. Of these: 19 (18%) died on the unit or very soon after discharge (within 28 days), 12% were transferred to an acute hospital due to inter-current illness. Two-thirds (66%) were discharged to a nursing home and 3% went home. By the time of the extraction in March 2020, 61 (58%) had died. The median survival time to the date of extraction was 24.3 months (IQR 6.9-43) for tracheostomised, compared with 40.9 (IQR 17.3-70.5) for those who were weaned. 172/250 (69%) were admitted in a prolonged disorder of consciousness (PDOC). Of these, 136 (79%) remained in PDOC discharge of which 74 (54%) still required a tracheostomy. The median survival time of this subgroup was lower (16.5 months (IQR 6.3-41.7)

Conclusions: Both being in PDOC and having a tracheostomy are strong predictors of non-survival, independent of age. PDOC is the stronger indicator, but tracheostomy itself carries a high risk of mortality.
These high rates of mortality should be taken into account when making treatment decisions for these individuals.