Characteristics and outcomes of trauma patients with unplanned intensive care unit admissions:Bounce backs and upgrades comparison  

作　　者：Alexander A Fokin Joanna Wycech Knight Phoebe K Gallagher Justin Fengyuan Xie Kyler C Brinton Madison E Tharp Ivan Puente 

机构地区：[1]Department of Trauma and Critical Care Services,Delray Medical Center,Delray Beach,FL 33484,United States [2]Department of Surgery,Florida Atlantic University Charles E Schmidt College of Medicine,Boca Raton,FL 33431,United States [3]Department of Trauma and Critical Care Services,Broward Health Medical Center,Fort Lauderdale,FL 33316,United States [4]Department of Surgery,Florida International University Herbert Wertheim College of Medicine,Miami,FL 33199,United States

出　　处：《World Journal of Critical Care Medicine》2025年第2期105-120,共16页世界重症医学杂志(英文)

摘　　要：BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and h

关 键 词：Unplanned intensive care unit admissions Trauma intensive care unit Bounce backs Upgrades Level 1 trauma center Geriatric trauma patients Quality of care indicator 

分 类 号：R47[医药卫生—护理学]