(722) Predictors for Requiring Tracheostomy in Medically Complex Patients Transitioning from Pediatric to Adult Care

Introduction: With increasing survival of medically complex patients with intellectual and developmental disabilities, the Adult Transition Medicine Clinic helps these patients navigate the transition from pediatric to adult care. This study aimed to identify risk factors for patients who will eventually require tracheostomy to optimize multidisciplinary care planning.

Methods: Retrospective cohort study of patients age >18 years enrolled in our tertiary care center’s Transition Clinic. Patients who underwent tracheostomy placement between 2005 and 2024 were compared to a cohort who did not receive tracheostomy. Baseline functional status and comorbidities were analyzed in STATA with chi-squared, univariate, and multivariate logistic regression.

Results: Eighty-nine patients were included; 19 (21%) underwent tracheostomy. Mean intake was 23 years for patients in both groups (p = 0.88). Mean age at tracheostomy placement was 27, and the average time from first transition clinic visit to placement was 4 years (median 3.75, range 1-10). Lower BMI was associated with tracheostomy (mean 20 vs 27 years; OR 0.85, CI 0.77 – 0.93). Indicators of functional status that were predictive of tracheostomy on univariate analysis were non-verbal status (OR 12.5, CI 2.8 – 63.2), gastrostomy tube dependence (OR 41.3, OR 9.8 – 173.7), and use of an assistive device for mobility (OR 12.7, CI 1.6 – 100.8). Comorbidities predictive of tracheostomy on univariate analysis were cerebral palsy (OR 8.7, CI 2.7 - 27.7), restrictive lung disease (OR 5.9 CI 1.4 - 24.7), scoliosis (OR 14.3, CI 3.7 - 54.7), seizure history (OR 14.4, CI 3.1 – 67.3), and home oxygen requirement (OR 8.0, CI 1.7 - 37.3). Sex, age at time of transition clinic intake, sleep apnea, cardiac disease, or use of a positive pressure device showed no significant association. No predictors remained significant on multivariate analysis.

Conclusions: Transition Clinics provide essential coordinated care for medically complex adults. Patients with low BMI, impaired functional status, and pulmonary disease may be at higher risk for tracheostomy and may benefit from additional screening.