Rethinking the Unplanned ICU Admission Quality Metric in Trauma Patients.
Zongyang Mou1, Parisa Oviedo1, Louis Perkins1
1Department of Surgery, University of California, San Diego, CA, USA.
The American Surgeon
|October 30, 2025
Summary
Unplanned ICU admission (UP-ICU) in trauma patients is not independently linked to higher mortality when adjusted for patient factors. This quality metric may help reduce failure to rescue by enabling early intervention for critical deterioration.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Health Services Research
Background:
- Unplanned ICU admission (UP-ICU) is a benchmark in trauma care, associated with increased mortality.
- The independent impact of UP-ICU on mortality versus confounding factors remains unclear.
Purpose of the Study:
- To determine if UP-ICU is independently associated with higher mortality after adjusting for patient physiology and injury severity.
Main Methods:
- Retrospective case-control study of adult trauma patients (2016-2020) at a Level 1 Trauma Center.
- 1:1 propensity score matching based on injury severity and comorbidities.
- Primary outcome: in-hospital mortality; secondary outcomes: discharge to rehabilitation and length of stay.
Main Results:
- In the unmatched cohort, UP-ICU was linked to higher mortality (8.6% vs 2.3%).
- After propensity score matching, mortality rates were similar between UP-ICU and non-UP-ICU groups (8.6% vs 7.4%).
- Common UP-ICU reasons: delayed intracranial hemorrhage, cardiac events, respiratory distress.
Conclusions:
- UP-ICU is not independently associated with increased mortality when adjusted for patient and injury factors.
- UP-ICU may serve as a quality metric to identify patients needing escalated care, potentially reducing failure to rescue.
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