Introduction: Severe head injury (SHI) patients require a specific treatment plan and nursing care to achieve an optimal clinical outcome. Patients with SHI may require a more extended period of hospitalisation for complex neuro-medical and neurosurgical management. Tracheostomy may be performed on head injury patients with protracted breathing problems. Early tracheostomy (ET) may improve the clinical outcomes of late tracheostomy. Objective: This study aims to determine the impact of ET on a patient's clinical outcomes before being discharged. Methods: This retrospective cohort study involves 45 SHI patients with tracheostomy in two Neuro-Centre hospitals in Klang Valley. The clinical outcome was observed before the participants were discharged, including the participant's GCS upon discharge, length of stay (LOS) in the ICU and hospital, the incidence of VAP, duration of mechanical ventilation dependency, and decannulation rate. Results: Crude analysis performed in this study showed that there is a significant association between tracheostomy classification (early and late) toward participant length of stay in the ICU with a p-value of <0.001, LOS in the hospital (p=0.002) and duration on the mechanical ventilation use (p<0.001) with no association with the GCS upon discharge (p=0.057), the incidence of VAP (p=0.374), and decannulation rate (p=0.081). Multivariate logistic regression analysis showed that the association between these variables remained significant for the LOS in the hospital (p=0.035) and duration of mechanical ventilation used (p=0.005). Conclusion: The initiation of ET contributes to a favourable clinical outcome regarding the duration of mechanical ventilation, and length of hospital stay for patients with a SHI. Future study to evaluate other outcomes, such as cognitive function and quality of life from the initiation of ET, is recommended to explore its benefit for the patient with a SHI.