H. Mulvey1, R. Haslam1, A. Laytin1, C. Sims1 1University of Pennsylvania,Trauma, Surgical Critical Care, And Emergency Surgery,Philadelphia, PA, USA
Introduction: Unplanned ICU admissions are associated with increased morbidity and mortality. The impact of these events on geriatric trauma patients, however, has not been previously investigated. We hypothesized that unplanned ICU admission is associated with negative outcomes in geriatric trauma patients and sought to identify predictive risk factors.
Methods: All trauma patients over the age of 65 admitted to an urban, academic, level I trauma center from January 1, 2012 to June 31, 2018 were identified. A prospectively collected administrative database was queried for demographics, co-morbidities, injury characteristics, and vital signs on admission. Outcomes including ICU days, overall length of stay, and mortality were assessed. The timing and incidence of complications was confirmed by review of the medical record. Univariate analysis was performed using Chi-square, Mann-Whitney U, and Student t-tests, where appropriate. Variables found to be significant underwent a binary logistic regression analysis. *p<0.05 =significant.
Results: Of the 2925 geriatric patients admitted during the study period, 96 (3.28%) patients experienced an unplanned admission to the ICU. Patients with unplanned ICU admissions were older (80.2±9.4 v. 78.4±9.0, p=0.048), had a higher ISS (10 [5-17] v. 9 [4-13], p<0.001), more comorbidities (3.8±1.8 v. 3.4±2.2, p=0.033), and a higher Charlson Comorbidity Index (5 [4-6] v. 4 [3-5], p=0.024). On logistic regression, however, only ISS was predictive of unplanned ICU admission. Interestingly, 68 of the unplanned ICU admissions (70.8 %) were unplanned ICU readmissions (4.7% v. 1.9%, p <0.001; OR 2.3, p=0.001). Patients with unplanned ICU admission experienced longer hospital stays (20.1 ± 19.5 v. 6.7 ± 7.4, p<0.001), more days in the ICU (10.1 ± 11.7 v. 2.3 ± 5.6, p<0.001), more complications (2.8 ± 2.0 v. 1.8 ± 1.4, p<0.001), and higher rates of mortality (11.5% v. 5.0%, p=0.019).
Conclusion: Geriatric trauma patients who require an unplanned ICU admissions experience significantly higher morbidity and mortality. Although ISS strongly predicted the need for unplanned ICU admission, the median ISS for these patients was only 10 suggesting that “at risk” elders could potentially be under-triaged to the floor. Given that unplanned admissions occur more frequently in patients previously admitted to the ICU, strategies that provide an extra layer of care such as step-down units or geriatric consultation could potentially improve outcomes.