Objective: A majority of patients with severe head injury whether treated conservatively or being operated, need ventilatory support and require endotracheal intubation. There has been a great discussion regarding the timing of tracheostomy. In this study we observed our admitted patients with severe head injury and noted the role of early tracheostomy in the outcome of these patients.Material and Method: This study included 50 cases of severe head injury presenting in the emergency department of Neurosurgery, Lahore General Hospital, Lahore.Study Duration: The study duration was two years from October 2010 to October 2012.Study Design: Prospective and analytic study.Results: A total of 50 patients with no sex predilection, ages ranging from 10 years to 60 years were included in this study. The patients were divided into 2 groups. Group A, having 25 patients who underwent tracheostomy earlier and Group B, having 25 patients in whom tracheostomy was done late. According to the timing of tracheostomy, patients were classified as early group A (? 7 days; N = 25) or late group B (> 7 days; N = 25). The average time of the tracheostomy procedure was 5.5 ± 1.8 (SD) days in the early group and 11.0 ± 4.3 days in the late group. There were no significant differences between the groups in terms of age, proportion of female sex, GCS, Injury Severity Score, or need for blood transfusion. However, patients in the early group had a significantly shorter stay in the ICU than patients in the late group (19.76 ± 4.4 vs. 28.9 ± 5.6 days; P = 0.0000001). There was no difference between the groups in ventilator days (15.7 ± 6.0 vs. 20.0 ± 16.0 days; p = 0.57) data not shown. There were significant differences between the groups regarding overall mortality 4% vs. 24%; p = 0.041332. Similarly, significant recovery (p = 0.04) was observed in early tracheostomy patients when compared with group B. Conclusion: Early tracheostomy was beneficial, resulting in a shorter ICU stay and decreasing the overall mortality
