TRACHY Score Calculator

Purpose. The TRACHY score is a simple, clinically oriented tool to guide post-operative airway management in patients with head and neck cancer undergoing resection with primary flap reconstruction. It helps identify patients who can be managed safely with endotracheal intubation alone and those in whom an elective tracheostomy is indicated.

Based on: Mohamedbhai H, Ali S, Dimasi I, Kalavrezos N. TRACHY score: a simple and effective guide to management of the airway in head and neck cancer. Br J Oral Maxillofac Surg. 2018;56:709–714.

Enter pre-operative variables

T – Tumour T-stage (TNM)
Use the clinical T-stage used for surgical planning.
R – Type of reconstruction
Select the single category that best describes the planned reconstruction.
A – Anatomy of tumour (site category)
Categories as per original study (e.g., anterior floor of mouth / oropharyngeal sites vs lateral or central oral cavity). Reference: Schache A, Lieger O, Rogers P, et al. Predictors of swallowing outcome in patients treated with surgery and radiotherapy for advanced oral and oropharyngeal cancer. Oral Oncol 2009;45:803–9.
C – Coexisting conditions (ASA grade)
ASA = American Society of Anesthesiologists physical status classification.
H – History of previous treatment for head & neck cancer
If both operation and radiotherapy are present, score according to radiotherapy (higher risk).
Y – Laterality (neck dissection)
Result
Threshold as per original study: a TRACHY score of 4 or more indicated tracheostomy with sensitivity 91.4%, specificity 90.8%, positive predictive value 90.9%, and negative predictive value 88.2%. This app reproduces that model and is intended as an adjunct to, not a replacement for, multidisciplinary clinical judgement and local protocols.