Mortality Increased for Children Whose Caregivers Decline Tracheostomy

WEDNESDAY, June 21, 2023 (HealthDay News) -- Less than half of critically ill children survive when caregivers decline tracheostomy placement, according to a study published online April 25 in The Laryngoscope.

Palmila Liu, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues conducted a retrospective cohort study involving all critically ill children obtaining a pretracheostomy consultation at a tertiary children's hospital between 2016 and 2021. Tracheostomy was declined for 58 children and placed for 203 children. Comorbidities and mortality were compared for those whose caregivers declined or agreed to tracheostomy.

The researchers found that mortality was 52 percent when declining and 21 percent when agreeing to tracheostomy at a mean of 10.7 and 18.1 months, respectively. For those declining, 31 percent died during hospitalization within a mean of 1.2 months and 21 percent died at a mean of 23.6 months after discharge. Older age (odds ratio [OR], 0.85) and chronic lung disease (OR, 0.18) were associated with lower odds of mortality among children of caregivers declining tracheostomy, while sepsis (OR, 9.62) and intubation (OR, 4.98) were associated with increased odds of mortality. After declining tracheostomy, median survival was 31.9 months, and declining placement was associated with an increased risk for mortality (hazard ratio, 4.04).

"The decision to place a tracheostomy in a child is a very difficult task for most families who face it," a coauthor said in a statement. "This study doesn't dictate which children should or should not receive a tracheostomy but will help families contemplating what might happen if they decide to withhold placement."

One author is editor-in-chief of Laryngoscope Investigative Otolaryngology.

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