Unplanned ICU Admission Is Associated With Worse Clinical Outcomes in Geriatric Trauma Patients
| Autor: | Carrie A. Sims, Hillary E. Mulvey, Carrie A. Diamond, Richard D. Haslam, Adam D. Laytin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Population Comorbidity Patient Readmission law.invention 03 medical and health sciences Injury Severity Score Patient Admission 0302 clinical medicine Trauma Centers Geriatric trauma Risk Factors law medicine Humans Registries education Aged Retrospective Studies Aged 80 and over education.field_of_study Univariate analysis business.industry Medical record Trauma center Age Factors Trauma quality improvement program Length of Stay medicine.disease Survival Analysis Intensive care unit Intensive Care Units 030220 oncology & carcinogenesis Emergency medicine Wounds and Injuries Female 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Journal of Surgical Research. 245:13-21 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2019.06.059 |
| Popis: | Geriatric trauma patients who require an unplanned ICU admission (UIA) may experience worse outcomes. As such, the American College of Surgeons initiated the Trauma Quality Improvement Program which tracks UIA as a quality benchmark. We sought to determine the overall rate and impact of UIA in our geriatric trauma population and to identify predictive risk factors.All geriatric trauma patients (≥65) admitted to an urban, level I trauma center from January 2012 to June 2018 were identified. A retrospectively collected administrative database was queried for demographics, comorbidities, injury characteristics, and outcomes. UIA were identified and medical records were queried. Univariate analysis followed by binary logistic regression analysis were performed (P 0.05 = significant).Of the 2923 geriatric patients identified, 95 (3.3%) patients experienced UIA, most commonly secondary to respiratory (34.7%) and cardiac (22.1%) events. Patients with UIA were older (81 versus 78, P = 0.04), and had higher injury severity score (10 versus 9, P 0.01) and Charlson comorbidity indices (5 versus 4, P = 0.02). On logistic regression, age (OR 1.027, P = 0.04) and injury severity score (OR 1.032, P 0.01) were predictive of unplanned ICU admission. Of the UIA, 69.4% were readmissions, or "bounce backs". Patients initially admitted to the ICU had 2.5 increased odds of requiring UIA. Patients with UIA experienced longer hospital stays (15 versus 5, P 0.01), more days in the ICU (6 versus 1, P 0.01), and higher rates of mortality (11.6% versus 5.0%, P = 0.02).Despite relatively low injury severity, geriatric trauma patients requiring UIA have a significant increase in morbidity and mortality. Those initially admitted to the ICU are at especially high risk for UIA, suggesting the benefit of strategies to provide an extra layer of care post-ICU. |
| Databáze: | OpenAIRE |
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