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Traumatic Brain Injury Patients Admitted on High-Census Days Receive Less Critical Care and Have an Increased Risk
David R Velez1, Anthony J Duncan1, Khaled Zreik2
1Department of General Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, USA.
Cureus
|September 2, 2024
Summary
High patient census in trauma services increases delirium rates in mild traumatic brain injury (TBI) patients. Moderate TBI patients may be under-triaged to the ICU during high-census periods, indicating a need for revised care strategies.
Area of Science:
- Trauma Surgery
- Neurocritical Care
- Health Services Research
Background:
- Growing healthcare utilization impacts clinical outcomes.
- Increased hospital census correlates with higher admission rates and resource utilization.
- Traumatic brain injury (TBI) is a significant cause of mortality and disability, necessitating research into factors influencing outcomes.
Purpose of the Study:
- To investigate the relationship between healthcare provider patient census and clinical outcomes in TBI patients.
- To determine if patient census affects TBI patient management and outcomes at a level I trauma center.
Main Methods:
- Retrospective review of 1,527 TBI patients from 2017 to 2022.
- Classification of high- and low-census days based on the mean daily patient count in the trauma service.
- Analysis of patient demographics, injury characteristics, and clinical outcomes using adjusted regression models.
Main Results:
- Demographics were similar between high- and low-census days.
- Moderate TBI patients were less likely (30%) to be admitted to the ICU on high-census days.
- Delirium rates were significantly higher on high-census days, particularly in mild TBI patients.
Conclusions:
- High patient census is associated with increased delirium in mild TBI patients.
- Potential under-triage of moderate TBI patients to the ICU during high-census periods was observed.
- Further research is needed to optimize TBI patient care strategies amidst fluctuating healthcare demands.
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