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Outcomes and predictors of unplanned intensive care unit admission for pediatric trauma patients
Tyler Liang1, Areg Grigorian1, Robert Painter1
1Division of Trauma, Burns, Critical Care & Acute Care Surgery, University of California Irvine, 101 The City Dr S, Orange, CA 92868, USA.
Insights
Unplanned intensive care unit (ICU) admission is rare in pediatric trauma patients but linked to worse outcomes. Ureteral, esophageal, and brain injuries are key predictors of this adverse event.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Patient Safety
Background:
- Unplanned intensive care unit (ICU) admission (UIA) is a known complication in adult trauma care.
- Limited research exists on the incidence and predictors of UIA in pediatric trauma patients (PTPs).
- Understanding UIA in PTPs is crucial for improving patient outcomes and resource allocation.
Purpose of the Study:
- To identify predictors of unplanned intensive care unit admission in pediatric trauma patients.
- To investigate the association between UIA and mortality in PTPs.
- To establish risk factors for UIA in this vulnerable population.
Main Methods:
- Utilized the 2017-2019 Trauma Quality Improvement Program (TQIP) database.
- Included pediatric trauma patients (≤16 years old) admitted to non-ICU levels of care.
- Performed multivariable logistic regression to identify predictors of UIA.
Main Results:
- Identified 233 cases of UIA (<1%) among 142,160 PTPs.
- UIA was associated with increased acute kidney injury (2.6% vs 0%), longer length of stay (7 vs 2 days), and higher mortality (1.3% vs 0.1%).
- Independent predictors of UIA included ureteral, esophageal, and brain injuries.
Conclusions:
- Unplanned intensive care unit admission is infrequent in pediatric trauma patients but significantly increases morbidity and mortality.
- Specific injuries, namely ureteral, esophageal, and brain trauma, are strong predictors of UIA in PTPs.
- Early identification of these predictors can guide preventative strategies and improve care for pediatric trauma patients.
Background:
Unplanned intensive care unit (ICU) admission (UIA) is associated with increased morbidity in adult trauma patients, however, is not well studied in pediatric trauma patients (PTPs). We sought to identify predictors of UIA, hypothesizing PTPs with UIA have increased odds of mortality.
Methods:
The 2017-2019 Trauma Quality Improvement Program (TQIP) database was queried for PTPs ≤16-years-old admitted to non-ICU level of care. Patients with UIA were compared to those without UIA. Multivariable logistic regression analysis was performed to determine predictors of UIA.
Results:
From 142,160 PTPs, 233 patients had UIA (<1 %). The UIA group had increased acute kidney injury (2.6 % vs 0 %, p < 0.001), length of stay (7 vs 2 days, p < 0.001), and mortality (1.3 % vs. 0.1 %, p < 0.001). Independent predictors of UIA included ureteral, esophageal, and brain injury (all p < 0.001).
Conclusion:
UIA for PTPs is rare but associated with increased complications and death. Significant predictors of UIA include ureteral, esophageal and brain injury.
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