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An analysis of outcomes and predictors of intensive care unit bouncebacks in a mature trauma system
Eric H Bradburn1, Shreya Jammula, Michael A Horst
1From the Trauma Services (E.H.B., S.J., M.A.H., M.M., T.M.V., B.W.G., J.A.M., D.V.N., F.B.R.), Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; University of Texas Health Science Center at Tyler (A.D.C), UT Health East Texas, Tyler, TX; and Department of Trauma and Surgical Critical Care (P.K.K.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Unplanned intensive care unit (ICU) readmissions, known as ICU bouncebacks, significantly increase patient mortality by 70%. Key predictors include unplanned intubation, sepsis, and pulmonary embolism, highlighting areas for trauma system improvement.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Public Health Surveillance
Background:
- Statewide data revealed unplanned intensive care unit (ICU) admissions as a critical issue in Pennsylvania's trauma community.
- Understanding the impact of unplanned ICU readmissions (ICU bouncebacks) on patient outcomes is essential for improving trauma care.
Purpose of the Study:
- To determine the effect of unplanned ICU admission/readmission on mortality.
- To identify potential predictors of unplanned ICU readmissions in trauma patients.
Main Methods:
- Retrospective analysis of the Pennsylvania Trauma Outcome Study database (2012-2015).
- Comparison of unadjusted mortality rates between ICU bounceback (ICUBB) and non-ICUBB patients.
- Multilevel mixed-effects logistic regression models to assess the adjusted impact of ICUBB and its predictors on mortality.
Main Results:
- The ICU bounceback rate was 3.82%.
- ICU bounceback patients exhibited a significantly higher mortality rate (12% vs. 8%, p < 0.001).
- ICUBB was associated with a 70% increased odds of mortality (aOR, 1.70; p < 0.001), with unplanned intubation, sepsis, and pulmonary embolism as key predictors.
Conclusions:
- ICU bouncebacks are linked to worse patient outcomes and are associated with specific complications, particularly respiratory issues.
- These findings underscore the value of collaborative initiatives like the TQIP Collaborative in identifying and addressing performance improvement opportunities in trauma systems.
Background:
With the recent birth of the Pennsylvania TQIP Collaborative, statewide data identified unplanned admissions to the intensive care unit (ICU) as an overarching issue plaguing the state trauma community. To better understand the impact of this unique population, we sought to determine the effect of unplanned ICU admission/readmission on mortality to identify potential predictors of this population. We hypothesized that ICU bounceback (ICUBB) patients would experience increased mortality compared with non-ICUBB controls and would likely be associated with specific patterns of complications.
Methods:
The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2012 to 2015 for all ICU admissions. Unadjusted mortality rates were compared between ICUBB and non-ICUBB counterparts. Multilevel mixed-effects logistic regression models assessed the adjusted impact of ICUBB on mortality and the adjusted predictive impact of 8 complications on ICUBB.
Results:
A total of 58,013 ICU admissions were identified from 2012 to 2015. From these, 53,715 survived their ICU index admission. The ICUBB rate was determined to be 3.82% (2,054/53,715). Compared with the non-ICUBB population, ICUBB patients had a significantly higher mortality rate (12% vs. 8%; p < 0.001). In adjusted analysis, ICUBB was associated with a 70% increased odds ratio for mortality (adjusted odds ratio, 1.70; 95% confidence interval, 1.44-2.00; p < 0.001). Adjusted analysis of predictive variables revealed unplanned intubation, sepsis, and pulmonary embolism as the strongest predictors of ICUBB.
Conclusion:
Intensive care unit bouncebacks are associated with worse outcomes and are disproportionately burdened by respiratory complications. These findings emphasize the importance of the TQIP Collaborative in identifying statewide issues in need of performance improvement within mature trauma systems.
Level Of Evidence:
Epidemiological study, level III.
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