| Autor: |
O’Quinn, Payton C., Gee, Kaylan N., King, Sarah A., Yune, Ji-Ming J., Jenkins, Jacob D., Whitaker, Fiona J., Suresh, Sapna, Bollig, Reagan W., Many, Heath R., Smith, Lou M. |
| Zdroj: |
The American Surgeon; September 2024, Vol. 90 Issue: 9 p2285-2293, 9p |
| Abstrakt: |
Background:Unplanned readmission to intensive care units (UR-ICU) in trauma is associated with increased hospital length of stay and significant morbidity and mortality. We identify independent predictors of UR-ICU and construct a nomogram to estimate readmission probability. Materials and Methods:We performed an IRB-approved retrospective case-control study at a Level I trauma center between January 2019 and December 2021. Patients with UR-ICU (n = 175) were matched with patients who were not readmitted (NR-ICU) (n = 175). Univariate and multivariable binary linear regressionanalyses were performed (SPSS Version 28, IBM Corp), and a nomogram was created (Stata 18.0, StataCorp LLC). Results:Demographics, comorbidities, and injury- and hospital course-related factors were examined as potential prognostic indicators of UR-ICU. The mortality rate of UR-ICU was 22.29% vs 6.29% for NR-ICU (P< .001). Binary linear regression identified seven independent predictors that contributed to UR-ICU: shock (P< .001) or intracranial surgery (P= .015) during ICU admission, low hematocrit (P= .001) or sedation administration in the 24 hours before ICU discharge (P< .001), active infection treatment (P= .192) or leukocytosis on ICU discharge (P= .01), and chronic obstructive pulmonary disease (COPD) (P= .002). A nomogram was generated to estimate the probability of UR-ICU and guide decisions on ICU discharge appropriateness. Discussion:In trauma, UR-ICU is often accompanied by poor outcomes and death. Shock, intracranial surgery, anemia, sedative administration, ongoing infection treatment, leukocytosis, and COPD are significant risk factors for UR-ICU. A predictive nomogram may help better assess readiness for ICU discharge. |
| Databáze: |
Supplemental Index |
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