Unplanned intensive care unit admission following trauma

Unplanned ICU Admission Is Associated With Worse Clinical Outcomes in Geriatric Trauma Patients

“…Of the 2923 patients, 95 (3.3%) experienced UIA during their hospital course including 66 bounce backs (69.5%) and 29 unplanned upgrades (30.5%). On average, patients requiring UIA were older (81 [72-88] versus 78 [70-86], P ¼ 0.04) and more severely injured as measured by ISS (10 [5-17] versus 9 [4][5][6][7][8][9][10][11][12][13] , P < 0.01). Of note, only 26.3% of patients who required UIA had an ISS >15.…”

“…Patients requiring UIA had significantly worse outcomes, including increased LOS (15 [9-24] versus 5 [3][4][5][6][7][8], P < 0.01) more days in the ICU (6 [3][4][5][6][7][8][9][10][11] versus 1 [0-2], P < 0.01) and higher mortality rates (11.6% versus 5.0%, P ¼ 0.02) ( Table 3). These patients also experienced more complications during admission, including acute respiratory distress syndrome (4.2% versus 0.42%, P ¼ 0.001), unplanned intubation (24.2% versus 1.4%, P < 0.01), AKI (5.3% versus 0.6%, P < 0.01), infections (4.2% versus 0.8%, P ¼ 0.01), DVT (8.4% versus 1.6%, P < 0.01), and sepsis (9.5% versus 1.3%, P < 0.01) ( Table 3).…”

“…Acute respiratory failure (%) 1. [4][5][6][7][8][9][10][11], P < 0.01), and more total complications (3 [1-4] versus 0 [0-0], P < 0.01). These complications included unplanned intubation (25.8% versus 2.8%, P < 0.01), AKI (6.0% versus 1.0%, P ¼ 0.01), DVT (12.1% versus 3.1%, P < 0.01), infection (6.0% versus 1.4%, P ¼ 0.02), and sepsis (13.6% versus 2.3%, P < 0.01) ( Table 6).…”

“…4,8,9 In the trauma population, Rubano et al identified major surgeries, age, and heart disease among risk factors associated with UIA. 10 Moreover, initiatives to identify high-risk patients and prevent UIA have shown success in improving outcomes, including use of early warning scoring systems to detect high-risk medical and surgical patients. 11 Although prior studies have assessed risk factors for ICU readmission in various settings, none have focused specifically on geriatric trauma patients.…”

“…11 Although prior studies have assessed risk factors for ICU readmission in various settings, none have focused specifically on geriatric trauma patients. 4,9,10,12,13 Furthermore, few studies have included patients who required unplanned upgrade to the ICU after initial admission to the floor. Identifying and addressing risk factors for UIA in geriatric trauma patients is critical for improving patient outcomes.…”