Abstract
Background
Information on the incidence, indications and morbidity of pediatric tracheotomy from a nationwide setting is sparse.
Methods
From the nationwide Danish National Patient Registry, we identified all cases: 0–15-year-old children registered with a first-time tracheotomy from 1979 to 2014. We extracted the date of surgery, admission, discharge, age, gender, hospital, department, hospitalization length, hospital contacts, and diagnosis-code related to the surgery. We estimated age-adjusted incidence rates (AAIR) and annual (APC) and average annual percentage change (AAPC) of tracheotomy incidence.
Results
A total of 510 children (328 boys, 63%) underwent tracheotomy. The median age at surgery was 8 years. The AAIR was 1.4/100,000 person-years (range 1.0–1.8) from 1980 to 2014. During 1979–2014, the AAPC decreased − 0.9% (95% confidential interval – 2.4; 0.8, p < 0.3). From 1979 to 2003 the APC decreased − 4.1% (95% CI − 5.4; − 2.8, p < 0.001) and from 2003 to 2014 the APC increased 6.6% (95% CI 2.0; 11.5, p < 0.001). Infants had the highest incidence (4.0/100,000 years) compared with the 12–15-year-olds (AAIR: 0.4/100,000 years). From 1979 to 2014 the most common indication for tracheotomy among children aged 0–2 years was congenital malformations (n = 48, 30%) and among children aged 3–11 and 12–15 years the most common indication was trauma (respectively n = 67, 36% and n = 85, 52%). During 2006–2014 the most common indications for all ages was neurological impairment (n = 25, 21%) and neoplasms (n = 20, 17%).
Conclusions
Pediatric tracheotomy was a rare surgical procedure with decreasing incidence rates from 1980–89 to 1990–99 and increasing incidence rates from 2000–2009 to 2010–2014. Indications and postoperative morbidity have changed adjunct to the treatment of chronic disorders.
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References
Lewis CW, Carron JD, Perkins JA, Sie KC, Feudtner C (2003) Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg 129:523–529
Grønhøj C, Charabi B, Buchwald CV, Hjuler T (2017) Indications, risk of lower airway infection, and complications to pediatric tracheotomy: report from a tertiary referral center. Acta Otolaryngol 137(8):868–871
Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, O’Brien J, Putney H, Goldmann DA (2010) Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child 95:703–710
Perez-Ruiz E, Caro P, Perez-Frias J, Cols M, Barrio I, Torrent A, Garcia MA, Asensio O, Pastor MD, Luna C, Torres J, Osona B, Salcedo A, Escribano A, Cortell I, Gaboli M, Valenzuela A, Alvarez E, Velasco R, Garcia E (2012) Paediatric patients with a tracheostomy: a multicentre epidemiological study. Eur Respir J 40:1502–1507
Ozmen S, Ozmen OA, Unal OF (2009) Pediatric tracheotomies: a 37-year experience in 282 children. Int J Pediatr Otorhinolaryngol 73:959–961
Corbett HJ, Mann KS, Mitra I, Jesudason EC, Losty PD, Clarke RW (2007) Tracheostomy–a 10-year experience from a UK pediatric surgical center. J Pediatr Surg 42:1251–1254
Zenk J, Fyrmpas G, Zimmermann T, Koch M, Constantinidis J, Iro H (2009) Tracheostomy in young patients: indications and long-term outcome. Eur Arch Otorhinolaryngol 266:705–711
StatBank Denmark. Statistics Denmark Web site: http://www.statistikbanken.dk/folk1c. Accessed 17 Jan 2018
StatBank Denmark. Statistics Denmark Web site: http://www.statistikbanken.dk/fod. Accessed 17 Jan 2018
Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33
Danish Health Authority: Danish classification of surgical procedures and therapies. ftp://filer.sst.dk/filer/sks/data/skscomplete/. Accessed 17 Jan 2018
Nordic Centre for Classification in Health Care. The NOMESCO classification of surgical procedures v. 1.16. http://www.nordclass.se/NCSP_1_16.pdf. Accessed 17 Jan 2018
StatBank Denmark. Statistics Denmark Web site: http://statistikbanken.dk/folk2. Accessed 17 Jan 2018
Juul S: Epidemiologi og Evidens, Svend Juul, Munksgaard, 2004; 2004
Wetmore RF, Handler SD, Potsic WP (1982) Pediatric tracheostomy. Experience during the past decade. Ann Otol Rhinol Laryngol 91:628–632
Crysdale WS, Feldman RI, Naito K (1988) Tracheotomies: a 10-year experience in 319 children. Ann Otol Rhinol Laryngol 97:439–443
Mahadevan M, Barber C, Salkeld L, Douglas G, Mills N (2007) Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 71:1829–1835
Kremer B, Botos-Kremer AI, Eckel HE, Schlondorff G (2002) Indications, complications, and surgical techniques for pediatric tracheostomies—an update. J Pediatr Surg 37:1556–1562
Ang AH, Chua DY, Pang KP, Tan HK (2005) Pediatric tracheotomies in an Asian population: the Singapore experience. Otolaryngol Head Neck Surg 133:246–250
Ogilvie LN, Kozak JK, Chiu S, Adderley RJ, Kozak FK (2014) Changes in pediatric tracheostomy 1982–2011: a Canadian tertiary children’s hospital review. J Pediatr Surg 49:1549–1553
Tantinikorn W, Alper CM, Bluestone CD, Casselbrant ML (2003) Outcome in pediatric tracheotomy. Am J Otolaryngol 24:131–137
Laursen B, Nielsen LT, Christensen PH, Møller H, Frimodt-Møller B (2006) Børneulykker i Danmark. En registerbaseret analyse (Childhood injuries in Denmark—a report in Danish with an English summary). National Institute of Public Health, Copenhagen. http://www.si-folkesundhed.dk/upload/b%C3%B8rnerapport_samlet1.pdf. Accessed 17 Jan 2018
Hospitalizations of children aged 0–15 years, data extraction from The Danish National Patient Register, 10 April 2015. http://esundhed.dk/sundhedsregistre/LPR/Sider/LPR.aspx
Funding
This study was funded by the Candys Foundation and Kræftfonden (The Cancer Foundation) (no grant numbers) (CG). The funder had no role in the experimental design, data analysis and interpretation, or manuscript preparation, approval, or submission.
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Data analysis and management: MSR with support from TH and CG. All authors contributed to writing the paper.
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All authors declare that they have no conflict of interest.
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This article does not contain any studies with human participants or animals performed by any of the authors. The study was approved by the Danish Data Surveillance Authority (No. 30-1471).
Appendix A
Appendix A
Indication of tracheotomy: categorization of diagnoses according to ICD-8 and ICD-10 codes: trauma (800–999 and S00-T98), congenital malformations (740–759 and Q00-99), neurological impairment (320–358 and G00-99), neoplasms (140–239 and C00-D48), upper airway infections (460–466, 50,800–50,805 and J00-06), upper airway anomaly (50,806, 51,992, J380-382, J385, J386, J955 and J980D), other respiratory diseases (470–493, 500-50709, 50,807–51,991, 51,993–51,999, 78,369, J09-37, J383, J384, J387-954, J958-980C, J980E-J99) and other which included the remaining.
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Resen, M.S., Grønhøj, C. & Hjuler, T. National changes in pediatric tracheotomy epidemiology during 36 years. Eur Arch Otorhinolaryngol 275, 803–808 (2018). https://doi.org/10.1007/s00405-018-4872-0
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DOI: https://doi.org/10.1007/s00405-018-4872-0