External laryngotracheal trauma: Incidence, airway control, and outcomes in a large Canadian center.

OBJECTIVES/HYPOTHESIS: Laryngotracheal trauma encompasses a subset of relatively uncommon yet life-threatening injuries requiring prompt intervention to prevent short- and long-term aerodigestive tract sequelae. Minimal literature exists regarding laryngotracheal injuries on a population level, particularly among Canadian centers.

STUDY DESIGN: Case series.

METHODS: Regional health databases containing in-patient admissions, emergency department visits, and trauma service activations using International Classification of Diseases (ICD) diagnostic codes were queried to identify all laryngotracheal injuries diagnosed from April 1, 1995, to December 31, 2011. Health records and diagnostic imaging were evaluated for mechanism, injuries, airway management, and long-term aerodigestive function.

RESULTS: Eighty-nine patients met inclusion criteria, equating to 1/1042 admissions and 1/2478 emergency presentations. Nineteen percent of injuries were severe (Schaefer-Fuhrman score ≥ 4). Airway intervention was performed at presentation in 65% of patients, with 13.5% necessitating emergent surgical airway; 52% underwent investigative or interventional airway surgery. Nine patients (16%) had long-term moderate or severe dysphonia; 14.5% had dysphagia. Odds ratio for death and long-term dysphonia among severe compared to minor laryngotracheal injuries were 7.1 (95% CI = 1.4-35.4) and 17.2 (95% CI = 3.3-91.1), respectively. Several factors were identified that predicted airway management and outcomes.

CONCLUSION: Traumatic laryngotracheal injuries are more common than previously reported, due to increased recognition. Many can be managed nonoperatively; however, cases require individual evaluation with judicious airway management and intervention to minimize aerodigestive sequelae. Severe injuries are associated with death and dysphonia but not with dysphagia.

LEVEL OF EVIDENCE: 4.