Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website https://www.neurores.org

Original Article

Volume 000, Number 000, July 2024, pages 000-000


Tracheostomy and Gastrostomy After Decompressive Craniectomy: What Surrogates Need to Know

Figures

Figure 1.
Figure 1. GOS/mRS outcomes over time. GOS: Glasgow Outcome Scale; mRS: modified Rankin Scale.
Figure 2.
Figure 2. Survival outcomes. GIP: general inpatient hospice.

Tables

Table 1. Patient Characteristics
 
CharacteristicT (n = 26)G (n = 29)T and/or G (n = 34)No T or G (n = 32)P value
T: tracheostomy; G: gastrostomy; SICU: surgical intensive care unit; NSICU: neuroscience intensive care unit; IPR: inpatient rehabilitation; SNF: skilled nursing facility; LTACH: long-term care hospital; GCS: Glasgow Coma Scale; IQR: interquartile range.
Age (median; IQR 25 - 75, in years)45; 30 - 5448; 37.5 - 58.548; 33.5 - 57.550; 37 - 610.1356
Sex0.9509
  Male18 (69.2%)17 (58.6%)21 (61.8%)20 (62.5%)
  Female8 (31.8%)12 (41.4%)13 (38.2%)12 (37.5%)
Etiology0.6786
  Trauma11 (42.3%)12 (41.4%)13 (38.2%)6 (18.7%)
  Ischemic stroke8 (31.8%)8 (27.6%)12 (35.3%)15 (46.8%)
  Hemorrhagic stroke7 (26.9%)9 (31.0%)9 (26.5%)11 (34.3%)
Dominant hemisphere surgery11 (42.3%)10 (34.5%)13 (38.3%)9 (28.1%)0.2102
Admission service0.0805
  Trauma/SICU15 (57.7%)13 (44.8%)16 (47.1%)9 (28.1%)
  Neurosurgery6 (23.1%)8 (27.6%)9 (26.5%6 (18.7%)
  Internal medicine0 (0.0%)1 (3.4%)1 (2.9%)0 (0.0%)
  Neurology/NSICU5 (8.9%)7 (24.1%)8 (23.5%17 (53.1%)
Admission GCS0.0832
  3 to 715 (57.7%)19 (65.5%)20 (58.8%)12 (37.5%)
  8 to 1511 (42.3%)10 (34.5%)14 (41.2%)20 (62.5%)
Preoperative GCS0.085
  3 to 720 (76.9%)21 (72.4%)25 (73.5)17 (53.1%)
  8 to 156 (23.1%)8 (27.6%)9 (26.5%)15 (46.9%)
Discharge disposition0.128
  Home, independent3 (11.5%)2 (6.8%)3 (8.8%)3 (9.4%)
  IPR9 (34.6%)15 (51.7%)15 (44.1%)12 (37.5%)
  SNF1 (3.8%)2 (6.8%)3 (8.8%)2 (6.3%)
  LTACH7 (26.9%)7 (24.1%)7 (20.6%)1 (3.1%)
  Transferred0 (0.0%)0 (0.0%)0 (0.0%)1 (3.1%)
  Died6 (23.1%)2 (6.8%)6 (17.6%)13 (40.6%)

 

Table 2. Timing of Events
 
EventTracheostomy and/or gastrostomy (n = 34)No tracheostomy or gastrostomy (n = 32)P value
P value represents statistical comparison of tracheostomy or gastrostomy data to no tracheostomy or gastrostomy data. IQR: interquartile range (from 25th percentile to 75th percentile).
Hours from admission to decompression (median)17.25 (IQR: 3 - 50.97) (n = 34)23.75 (IQR: 9.64 - 48.73) (n = 32)0.2299
Days from decompression to gastrostomy (median)10 (IQR: 7 - 16) (n = 29)--
Days from decompression to tracheostomy (median)7 (IQR: 3 - 11) (n = 26)--
Days from decompression to comfort care (median)46.5 (IQR: 15.5 - 252) (n = 3)4 (IQR: 2 - 6.5) (n = 10)0.2861

 

Table 3. Cause of Death
 
Cause of deathT (n = 6)G (n = 2)T and/or G (n = 6)No T or G (n = 13)
P = 0.3204 for comparison of tracheostomy and/or gastrostomy to no tracheostomy or gastrostomy. ICP: intracranial pressure; T: tracheostomy; G: gastrostomy.
Stable with withdraw of care0 (0.0%)0 (0.0%)0 (0.0%)2 (15.4%)
Not medically stable1 (16.8%)0 (0.0%)1 (16.7%)2 (15.4%)
Elevated ICP - withdrawal of care3 (50%)1 (50.0%)3 (50.0%)8 (61.5%)
Brain death2 (33.3%)1 (50.0%)2 (33.3%)1 (6.7%)