C. E. Horton1, S. L. Tannenbaum1, J. D. Berne1 1Broward Health Medical Center, Surgery, Fort Lauderdale, FL, USA
Introduction: Critically injured trauma patients are catabolic and many also present in a malnourished state based on body mass index, weight loss and poor nutrition intake, electrolyte levels, current alcohol/drug abuse, and gastrointestinal (GI) illnesses. These patients are at risk for worse outcomes and may develop comorbid conditions including refeeding syndrome, a catastrophic shift in electrolytes resulting from rapid introduction of nutrition. We aim to investigate if trauma patients with mitigating factors will have longer hospital length of stay (HLOS) than those trauma patients who do not present with these issues.
Methods: This was a retrospective observational study of malnourished patients ≥18 years of age (n=40) using merged data of patients from the trauma registry and the electronic medical records of two institutions (January 2016-June 2017). The patients were identified using the ICD-10 codes for malnutrition and at risk for poor outcomes by having at least two of the following: minimal nutritional intake for >5 days, BMI<18.5, unintentional weight loss>10% in the past 3-6 months or 5-10% in the past month, active alcohol/drug use, had major surgery during current hospital stay, low levels of electrolytes before feeding, or GI illness. Outcome measured was HLOS, a proxy for poor outcomes. Pearson’s correlation was used to determine the association between variables. Multiple linear regression was used to determine the significance of independent variables while adjusting for all other variables in the model.
Results: The mean age of the sample was 45.8 years (SD 20.9). Most (45.0%) were White, 42.5% were Black, and 12.5% were other races. The majority had a blunt mechanism of injury (82.5%) compared to penetrating trauma (17.5%). Mean HLOS was 11.5 days (SD 24.3). Slightly more than one quarter of patients (27.5%) had poor nutrition intake, <50% of requirements. There was a strong positive correlation between time NPO and HLOS (r=0.773[df17], P<0.0001) and a moderate negative correlation between admission albumin and HLOS (r=-0.515[df17], P=0.029). Multivariable analysis revealed longer HLOS was significantly influenced by younger age (P=0.029), poor nutrition intake (P<0.001), more ICU days (P<0.0001), higher admission potassium (P=0.036), and not receiving nutrition support (P=0.039).
Conclusion: Critically injured trauma patients who are malnourished are at risk for longer HLOS. We found a correlation between being NPO longer and lower admission albumin with longer HLOS in trauma patients. The results of this study strongly support younger age, poor nutrition intake, more days in the ICU, higher admission potassium, and not receiving nutrition support during hospital stay as predictors of increased HLOS. Monitoring of nutrition intake and electrolytes, fewer days NPO, and providing nutrition support to trauma patients may decrease HLOS and support more optimal outcomes.