Predicting Unplanned ICU Admission in Trauma: Early Warning Signs on the Floor

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Health Services Research

Background:

• Unplanned ICU admissions (UA-ICU) are a key metric associated with adverse outcomes in trauma care.
• Existing research has identified some predictors, but gaps remain in identifying at-risk patients, especially after initial ward admission.
• This study focuses on novel predictors and outcomes of UA-ICU specifically for trauma patients.

Purpose of the Study:

• To investigate novel predictors of unplanned ICU admissions in trauma patients.
• To analyze the outcomes associated with UA-ICU, including mortality, length of stay, and discharge disposition.
• To identify potential areas for improved patient monitoring and intervention strategies.

Main Methods:

• Retrospective cohort study at a single ACS-verified Level 1 Trauma Center (2019-2023).
• Compared 140 UA-ICU patients with 140 propensity-matched controls (never admitted to ICU).
• Propensity matching considered age, gender, mechanism of injury, ISS, and highest AIS values. Variables analyzed included demographics, injuries, comorbidities, labs, and pharmacology.

Main Results:

• UA-ICU patients had significantly higher mortality (22.1% vs 1.4%), longer LOS (10 vs 3 days), and fewer home discharges (33.6%).
• Predictive comorbidities included cirrhosis, active cancer, CHF, and home medications for seizures/loop diuretics.
• Between 48-72 hours post-admission, UA-ICU patients showed higher heart rates, lower hemoglobin and platelets, and required supplemental oxygen.

Conclusions:

• Established and novel predictors for UA-ICU in trauma patients were identified.
• UA-ICU is strongly associated with prolonged hospitalization, adverse outcomes, and increased mortality.
• Integrating additional predictors into clinical practice and scoring systems may optimize patient outcomes and resource conservation.