S. Kumar1, N. Nunes1, A. Elkbuli1 1Orlando Regional Medical Center, Orlando, FL, USA
Introduction: Sepsis poses a major risk for mortality in trauma patients; however, little is known about how emergency department length of stay (ED-LOS) may impact outcomes. We aim to evaluate the impact of ED-LOS on clinical outcomes in critically ill severely injured blunt trauma patients with severe sepsis.
Methods: This is a retrospective cohort study utilizing the American College of Surgeons (ACS) TQIP PUF database from 2017 to 2021 to investigate the effect of ED-LOS on clinical outcomes in adult (age ≥ 18) severely injured (ISS≥16), non-TBI (no head AIS) trauma patients with blunt injuries and diagnosis of severe sepsis admitted directly to the intensive care unit (ICU). Study outcomes included in-hospital mortality, ICU length-of-stay (ICU-LOS), ventilator-free days (VFD), and complications of sepsis.
Results: 1,754 patients were included in this analysis, of which 1,401 had an ED-LOS ≤ 3 hours and 353 had an ED-LOS between 3-6 hours. There were no significant differences in in-hospital mortality rates, ICU-LOS, VFDs, or incidence of ARDS. Patients with ED-LOS between 3-6 hours had 54% lower odds of developing an acute kidney injury (AKI) compared to patients with ED-LOS ≤3 hours (OR 0.458, 95% CI 0.248-0.845, p=0.012).
Conclusion: Severely ill septic trauma patients should be admitted to the ICU within 6 hours to ensure prompt critical care management while prioritizing hemodynamic stabilization and administration of necessary antibiotics to prevent the development of complications such as AKI.