Peter Kanuika, M.D.
Research Resident
Metrohealth Medical Center, United States
Disclosure information not submitted.
Laura Brown, MD, PhD
Assistant Professor of Surgery
Case Western University, MetroHealth Medical Center
Cleveland, Ohio
Disclosure information not submitted.
Vanessa Ho, M.D.
Trauma Surgeon
Metrohealth Medical Center, United States
Disclosure information not submitted.
Jeffrey Claridge, M.D.
Trauma Surgeon
Metrohealth Medical Center, United States
Disclosure information not submitted.
Title: Unplanned ICU Admission: Is Mortality Enough to Tell the Whole Story?
Introduction:
Unplanned ICU Admission (U-ICU) is thought to be associated with worse outcomes in trauma patients. Increased mortality of unplanned admissions to the Intensive Care Unit (ICU) has been described regionally, but not nationally. We intend to discern whether or not U-ICU correlates with increased mortality on a national scale.
Methods:
Patient with length of stay (LOS) > 2 days in the 2016 Trauma Quality Improvement Program were included. Patients with and without U-ICU were matched 1:1 via a propensity score. Match pairs were based on factors including mechanism, abbreviated injury scores, and medical comorbidities. Secondary outcomes included LOS, ICU LOS, ventilator days, other unplanned events (intubation or operation), and discharge disposition. Matched pair analysis was performed.
Results:
There were 246,153 patients identified, of whom 6,420 had unplanned admission to the ICU (2.6%). There were 5,399 matched pairs created, with effective reduction in bias. Post-match propensity score variables all had absolute standardized differences < 0.1. In matched pair analysis, U-ICU patients had higher mortality compared to patients without U-ICU (11.1% vs. 5.8%, p< 0.01). U-ICU was also associated with longer overall LOS (15 [9-25] vs 7 [4-12]), ICU LOS (7 [4-13] vs 2 [0-5], p< 0.001), more ventilator days (0 [0-1] vs 1 [0-6], p< 0.001), and fewer discharges to home (13.9% vs. 24.0%).
Conclusion:
Trauma patients with U-ICU admission had higher mortality, and were more likely to experience complications than patients without U-ICU. Future analyses will answer the question whether or not U-ICU correlates with patient rescue, after adjustment for severity of critical illness – a limitation of the present analysis.