J. A. Rubano1, J. A. Vosswinkel1, J. E. McCormack1, E. C. Huang1, M. Paccione1, R. S. Jawa1 1Stony Brook University Medical Center,Trauma,Stony Brook, NY, USA
Introduction: Unplanned Intensive Care Unit (UP-ICU) admission is a key quality measure of the American College of Surgeons Committe on Trauma. We sought to evaluate frequency, timing, risk factors, and morbidity associated with unplanned ICU admission following acute traumatic injury.
Methods: Retrospective analysis of a state-designated level I trauma center's registry. All adult trauma admissions from January 2007 through December 2013 were considered. Burns, isolated hip fractures, field/emergency department intubations and patients takend directly to the operating room were excluded. Univariate and multivariate statistical analyses were performed; p≤ 0.05 was considered significant.
Results: Of 5465 patients meeting study criteria, 85.2% required no ICU (NO-ICU) stay, 10.9% had planned (PL-ICU) admission, and 3.9% were UP-ICU admissions. Patient demographics are presented in the table. UP-ICU admissions more frequently had ≥2 National Trauma Data Standard comorbid conditions (65.1%) than NO-ICU (33.2%) and PL-ICU admissions (47.2%), p<0.05. Median length of stay prior to UP-ICU admission was significantly longer than PL-ICU admission (2 days, IQR 0-4 vs. 0 days, IQR 0-0). UP-ICU admissions had significantly more frequent strokes (2.4% vs 0.5%), MI (14.2% vs. 4.0%), respiratory failure (10.9% vs. 1.7%), pneumonia (30.2% vs. 9.9%), renal failure (7.6% vs. 2.7%), sepsis (10.9% vs. 2.9%), and DVT/PE (11,8% vs. 5.2%) as compared to PL-ICU admissions. Rates of these complications in the NO-ICU group were each ≤1.1% and correspondingly significantly less than in UP-ICU group. Finally, UP-ICU patients had a higher mortality (18.4%) than NO-ICU (0.49%, p<0.001) or PL-ICU admission groups (5.71%, p < 0.001). In subsequent multivariate logistic regression, risk factors for unplanned ICU admission were respiratory failure (odds ratio 3.74, 95% confidence interval 1.62-8.63), PE/DVT (2.27, 1.23-4.18), MI (1.98, 1.05-3.74), and pneumonia (2.60, 1.66-4.08). Age, presence of ≥ 2 comorbidities, sepsis, and stroke were not risk factors. ISS was slightly negatively associated with UP-ICU admission (OR 0.97 (95% CI 0.95 – 0.99).
Conclusion: Unplanned ICU admission is an infrequent but morbid event. It is associated with a threefold increase in mortality as compared to planned ICU admission. A slightly lower ISS in UP-ICU would be expected as these patients were not directly admitted to the ICU. Earlier identification of risk factors may decrease unplanned ICU admission.
