This study was presented at the Triological Society Annual meeting, Chicago, Illinois, April 29–30, 2011.
Article first published online: 6 SEP 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 10, pages 2122–2127, October 2011
How to Cite
Mendelsohn, A. H., Sidell, D. R., Berke, G. S. and John, M. St. (2011), Optimal timing of surgical intervention following adult laryngeal trauma. The Laryngoscope, 121: 2122–2127. doi: 10.1002/lary.22163
The authors have no financial disclosures for this article.
The authors have no conflidcts of interest to disclose.
- Issue published online: 21 SEP 2011
- Article first published online: 6 SEP 2011
- Accepted manuscript online: 20 JUL 2011 11:07AM EST
- Manuscript Accepted: 13 MAY 2011
- Manuscript Received: 12 APR 2011
- Adult laryngeal trauma;
- surgical intervention;
- Level of Evidence: 2c
Laryngeal trauma is an infrequent diagnosis with a scarcity of published data. We aim to further define the factors associated with positive surgical outcomes of adult laryngeal trauma.
Multi-institution database analysis.
Of the 1.9 million trauma cases from the National Trauma Database (NTDB), 564 adult trauma events were selected with ICD-9 codes specific to laryngeal trauma.
Laryngeal trauma was seen predominately in white (61.5%), middle-aged (40.6 years), male (83.7%) patients experiencing blunt (70.7%) laryngeal injury with multiorgan system (92.2%) trauma. There was an overall 17.9% mortality rate. Within the 564 cases, 133 direct laryngoscopies, 185 tracheostomies, 53 laryngeal suturing, and 60 laryngeal fracture repairs were performed. In univariate negative binomial regression models, trauma severity (P ≤ .01), placement of tracheostomy (P lt; .01), and delayed tracheostomy placement (P = .04, .03, .048) were associated with increased ventilator dependence, intensive care unit (ICU) stay, and overall hospital admission duration. Multivariate regression models demonstrated significant associations between tracheostomy performed within 24 hours and shortened ICU stay (P = .03, β = −.28, SE = 1.7) and overall hospital stay (P = .009, β = −.23, SE = 3.1).
The NTDB allows study of the largest laryngeal trauma cohort in modern literature. Although complexities arise in the treatment of laryngeal traumas, when indicated, surgical airway should be placed within 24 hours of presentation to improve the overall hospital course.