Skip to main content

Main menu

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
  • BMJ Journals

User menu

  • Login

Search

  • Advanced search
  • BMJ Journals
  • Login
  • Facebook
  • Twitter
TSACO

Advanced Search

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
Open Access

Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach

Joost D J Plate, Linda M Peelen, Luke P H Leenen, Falco Hietbrink
DOI: 10.1136/tsaco-2018-000228 Published 24 October 2018
Joost D J Plate
1 Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Joost D J Plate
Linda M Peelen
2 Julius Centre for Health Sciences and Primary Care, Utrecht University, , The Netherlands
3 Departments of Anesthesiology and Intensive Care Medicine, Utrecht University, Utrecht, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Luke P H Leenen
1 Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Falco Hietbrink
1 Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

  • Table 1

    Baseline of trauma admissions at the intermediate and intensive care units

    Total, n=1320IMCU, n=675ICU, n=645
    n (%)n (%)Missing, n (%)n (%)Missing, n (%)
    General characteristics
     Age (SD)52.3 (21.0)54.2 (20.5)0 (0.0%)50.3 (21.3)0 (0.0%)
     Sex, male (%)910 (68.9%)462 (68.4%)0 (0.0%)448 (69.5%)0 (0.0%)
    Trauma mechanism (%)
     Traffic—HET500 (37.9%)251 (37.2%)0 (0.0%)249 (38.6%)0 (0.0%)
     Traffic—LET130 (9.8%)57 (8.4%)73 (11.3%)
     Fall—HET136 (10.3%)76 (11.3%)60 (9.3%)
     Fall—LET373 (28.3%)207 (30.7%)166 (25.7%)
     Penetrating—firearms21 (1.6%)7 (1.0%)14 (2.2%)
     Penetrating—other59 (4.5%)36 (5.3%)23 (3.6%)
     Drowning5 (0.4%)0 (0.0%)5 (0.8%)
     Burn/inhalation trauma31 (2.3%)14 (2.1%)17 (2.6%)
     Other65 (4.9%)27 (4.0%)38 (5.9%)
    Global injury severity
     ISS (IQR)19 (13–26)17 (11–22)0 (0.0%)22 (14–30)0 (0.0%)
     Maximum AIS score (%)
      ≤3551 (41.7%)332 (49.2%)0 (0.0%)219 (34.0%)0 (0.0%)
      4543 (41.1%)288 (42.7%)255 (39.5%)
      5–6226 (17.1%)55 (8.1%)171 (26.5%)
    Head injury severity
     First ED GCS score
      14–15666 (54.6%)528 (78.2%)53 (7.9%)138 (21.4%)47 (7.3%)
      9–12152 (12.5%)75 (11.1%)77 (11.9%)
      ≤8402 (33.0%)19 (2.8%)383 (59.4%)
     Maximum head AIS score
      ≤2626 (47.4%)366 (54.2%)0 (0.0%)260 (40.3%)0 (0.0%)
      3160 (12.1%)84 (12.4%)76 (11.8%)
      4–6534 (40.5%)225 (33.3%)309 (47.9%)
    Thoracoabdominal injury severity
     Maximum thorax AIS score
      ≤2843 (63.9%)439 (65.0%)0 (0.0%)404 (62.6%)0 (0.0%)
      3260 (19.7%)135 (20.0%)125 (19.4%)
      4–6217 (16.4%)101 (15.0%)116 (18.0%)
     Maximum abdominal AIS score
      ≤21222 (92.6%)634 (93.9%)0 (0.0%)588 (91.2%)0 (0.0%)
      360 (4.5%)28 (4.1%)32 (5.0%)
      4–538 (2.9%)13 (1.9%)25 (3.9%)
    Extremity injury severity
     Maximum extremity AIS score
      ≤21108 (83.9%)570 (84.4%)0 (0.0%)538 (83.4%)0 (0.0%)
      3195 (14.8%)97 (14.4%)98 (15.2%)
      4–517 (1.3%)8 (1.2%)9 (1.4%)
    Vital signs at presentation (SD) (IQR)
     Systolic blood pressure135 (28.5)137 (24.6)29 (4.3%)133 (32.1)31 (4.8%)
     Respiratory rate19 (5.9)19 (5.3)123 (18.2%)18 (6.6)156 (24.2%)
     Saturation1.00 (0.97–1.00)1.00 (0.97–1.00)42 (6.2%)1.00 (0.97–1.00)57 (8.8%)
    Laboratory parameters at presentation (SD) (IQR)
     Hemoglobin8.5 (1.2)8.6 (1.0)38 (5.6%)8.3 (1.4)46 (7.1%)
     Lactate2.2 (1.5–3.3)2 (1.4–2.8)208 (30.8%)2.6 (1.7–3.9)135 (20.9%)
     pH7.4 (7.3–7.4)7.4 (7.4–7.4)174 (25.8%)7.3 (7.3–7.4)64 (9.9%)
     pCO2 44 (10.5)41 (7.5)174 (25.8%)47 (11.8)64 (9.9%)
     pO2 178 (99–292)149 (91–238)174 (25.8%)205 (106–349)64 (9.9%)
     HCO3 23.9 (3.6)24.4 (3.1)174 (25.8%)23.4 (4.0)64 (9.9%)
     BE−1.0 (−4.0 to 1.0)0.0 (−2.6 to 2.0)174 (25.8%)−2.0 (−5.0 to 1.0)49 (7.6%)
     Saturation1.00 (1.00–1.00)1.00 (1.00–1.00)202 (29.9%)1.00 (1.00–1.00)83 (12.9%)
    • This baseline table shows the overall characteristics of trauma admissions which received critical care during the study period, stratified per location of delivered critical care (intermediate or intensive care unit).

    • AIS, Abbreviated Injury Scale; BE, base excess; ED, emergency department; GCS, Glasgow Coma Scale; ICU, intensive care unit; IMCU, intermediate care unit; ISS, Injury Severity Score; HET, high energy trauma; LET, low energy trauma; BCA, bootstrapped confidence interval; ICP, Intracranial pressure.

  • Table 2

    Differences between trauma admissions at the neuro(surgical) and mixed-surgical intermediate care unit

    Neuro IMCU, n=324Surgical IMCU, n=351
    n (%)Missing, n (%)n (%)Missing, n (%)
    General characteristics
     Age (SD)58.3 (20.3)0 (0.0%)50.3 (20.0)0 (0.0%)
     Sex, male (%)212 (65.4%)0 (0.0%)250 (71.2%)0 (0.0%)
    Trauma mechanism
     Traffic—HET82 (25.3%)0 (0.0%)169 (48.1%)0 (0.0%)
     Traffic—LET43 (13.3%)14 (4.0%)
     Fall—HET25 (7.7%)51 (14.5%)
     Fall—LET153 (47.2%)54 (15.4%)
     Penetrating—firearms1 (0.3%)6 (1.7%)
     Penetrating—other8 (2.5%)28 (8.0%)
     Burn/inhalation trauma0 (0.0%)14 (4.0%)
     Other12 (3.7%)15 (4.3%)
    Global injury severity
     ISS (SD)18.1 (8.4)0 (0.0%)16.6 (9.2)0 (0.0%)
     Maximum AIS score
      ≤3107 (33.0%)0 (0.0%)225 (64.1%)0 (0.0%)
      4178 (54.9%)110 (31.3%)
      5–639 (12.0%)16 (4.6%)
    Head injury severity
     First ED GCS score
      14–15223 (68.8%)25 (7.7%)305 (86.9%)28 (8.0%)
      9–1262 (19.1%)13 (3.7%)
      ≤814 (4.3%)5 (1.4%)
     Maximum head AIS score
      ≤272 (22.2%)0 (0.0%)294 (83.8%)0 (0.0%)
      350 (15.4%)34 (9.7%)
      4–6202 (62.3%)23 (6.6%)
    Thoracoabdominal injury severity
     Maximum thorax AIS score
      ≤2273 (84.3%)0 (0.0%)166 (47.3%)0 (0.0%)
      332 (9.9%)103 (29.3%)
      4–619 (5.9%)82 (23.4%)
     Maximum abdominal AIS score
      ≤2322 (99.4%)0 (0.0%)312 (88.9%)0 (0.0%)
      32 (0.6%)26 (7.4%)
      4–50 (0.0%)13 (3.7%)
    Extremity injury severity
     Maximum extremity AIS score
      ≤2307 (94.8%)0 (0.0%)263 (74.9%)0 (0.0%)
      317 (5.2%)80 (22.8%)
      4–50 (0.0%)8 (2.3%)
    Vital signs at presentation (SD)[IQR]
     Systolic blood pressure139 (23.9)20 (6.2%)136 (25.2)9 (2.6%)
     Respiratory rate19 (5.3)66 (20.4%)19 (5.2)57 (16.2%)
     Saturation1.00 [0.97 to 1.00]30 (9.3%)1.00 [0.98 to 1.00]12 [3.4%]
    Laboratory parameters at presentation (SD)[IQR]
     Hemoglobin8.6 [8.5 to 8.7]22 (6.8%)8.7 [8.6 to 8.8]16 (4.6%)
     Lactate2.0 [1.5 to 2.9]128 (39.5%)1.9 [1.4 to 2.8]80 (22.8%)
     pH7.4 [7.4 to 7.4]116 (35.8%)7.4 [7.3 to 7.4]58 (16.5%)
     pCO2 40 (7.8)116 (35.8%)42 (7.0)58 (16.5%)
     pO2 154 [96 to 238]116 (35.8%)148 [88 to 243]58 (16.5%)
     HCO3 24.2 (3.0)116 (35.8%)24.6 (3.1)58 (16.5%)
     BE0.0 [−3.0 to 2.0]116 (35.8%)0.0 [−2.0 to 2.0]58 (16.5%)
     Saturation1.00 [1.00 to 1.00]129 (39.8%)1.00 [1 to 1.00]73 (20.8%)
    • The numbers presented here are the descriptive statistics of intermediate care unit admissions after sustained trauma, stratified per intermediate care unit: the neuro(surgical) and mixed-surgical.

    • AIS, Abbreviated Injury Scale; BE, base excess; ED, emergency department; GCS, Glasgow Coma Scale; IMCU, intermediate care unit; ISS, Injury Severity Score.

  • Table 3

    Trauma admissions at the intermediate and intensive care unit

     IMCUICU
    Total admission, nn=675n=645
    Admission characteristics
     Admission duration, median (IQR)32.8 [18.8–62.5]46.7 [16.8–155.5]
     Admissions <72 h, n (%)544 (80.6)380 (59.2%)*
    Transfer characteristics
     Hospital ward, n (%)592 (87.7)225 (34.9%)
     Intermediate care unit, n (%)–324 (50.4%)
     Intensive care unit, n (%)38 (5.6)–
     Home, n (%)44 (6.5)–
     Death at the hospital unit, n (%)1 (0.1)95 (14.8%)
    Indication ICU admission
     Mechanical ventilation, n (%)–620 (96.3%)
     No mechanical ventilation, n (%)–24 (3.7%)
     Risk of intubation due to head injury–5 (0.8%)
     Risk of intubation due to airway obstruction–3 (0.5%)
     Risk of pulmonary deterioration–3 (0.5%)
     Hemodynamic monitoring for bleeding or cardiac contusion–7 (1.1%)
     Exchange bed (IMCU full)*–6 (0.9%)
    Indication ICU transfer
     Postoperative after neurosurgical decompression, n (%)9 (1.3)–
     Postoperative after rib fixation, n (%)4 (0.6)–
     Postoperative after other operations†, n (%)7 (1.0)–
     Intubation due to respiratory deterioration, n (%)7 (1.0)–
     Intubation due to sepsis, n (%)2 (0.3)–
     Intubation for other reasons‡, n (%)6 (0.9)–
     Respiratory support with non-invasive ventilation, n (%)2 (0.3)–
     Multiple vasopressive medication, n (%)1 (0.1)–
    In-hospital mortality, n (%)23 (3.4)134 (20.8%)
    • The numbers presented are the indications, admission and transfer characteristics of intermediate care unit and intensive care unit admissions after sustained trauma.

    • *The exchange patients were admitted for other non-surgical disciplines due to full occupancy of their IMCU.

    • †Cholecystectomy due to perforated gallbladder, stabilization of the spine, thoracotomy, pelvic fixation, femoral nail placement.

    • ‡Atrial flutter, Guillain-Barré syndrome, combined respiratory and neurological deterioration, sedation to reduce the ICP, epileptic insult.

    • ICU, intensive care unit; IMCU, intermediate care unit.

  • Table 4

    Indications transfer from intermediate to intensive care unit (ICU) per intermediate care unit (neurosurgical and mixed-surgical)

    Indication ICU transfer, n (%)Total (n=38)Neuro (n=20)Surgical (n=18)
    Postoperative20 (52.6)1010
    Intubation due to respiratory deterioration7 (1.04)52
    Intubation due to sepsis2 (0.30)11
    Intubation for other reasons*6 (0.89)24
    Respiratory support with non-invasive ventilation2 (0.30)11
    Multiple vasopressive medication1 (0.15)10
    • *Atrial flutter, Guillain-Barré syndrome, combined respiratory and neurological deterioration, sedation to reduce the ICP, epileptic insult.

PreviousNext
Back to top
Email

Thank you for your interest in spreading the word on TSACO.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
(Your Name) has sent you a message from TSACO
(Your Name) thought you would like to see the TSACO web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
Joost D J Plate, Linda M Peelen, Luke P H Leenen, Falco Hietbrink
Trauma Surg Acute Care Open Oct 2018, 3 (1) e000228; DOI: 10.1136/tsaco-2018-000228

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Cite This
  • APA
  • Chicago
  • Endnote
  • MLA
Loading
Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
Joost D J Plate, Linda M Peelen, Luke P H Leenen, Falco Hietbrink
Trauma Surg Acute Care Open Oct 2018, 3 (1) e000228; DOI: 10.1136/tsaco-2018-000228
Download PDF

Share
Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
Joost D J Plate, Linda M Peelen, Luke P H Leenen, Falco Hietbrink
Trauma Surgery & Acute Care Open Oct 2018, 3 (1) e000228; DOI: 10.1136/tsaco-2018-000228
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Respond to this article
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Article
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Intraoperative REBOA: an analysis of the American Association for the Surgery of Trauma AORTA registry
  • Opioid stewardship after emergency laparoscopic general surgery
  • Comparative analysis of isoform-specific and non-selective histone deacetylase inhibitors in attenuating the intestinal damage after hemorrhagic shock
Show more Original article

Similar Articles

 
 

CONTENT

  • Latest content
  • Archive
  • eLetters
  • Sign up for email alerts
  • RSS

JOURNAL

  • About the journal
  • Editorial board
  • Thank you to our reviewers
  • The American Association for the Surgery of Trauma

AUTHORS

  • Information for authors
  • Submit a paper
  • Track your article
  • Open Access at BMJ

HELP

  • Contact us
  • Reprints
  • Permissions
  • Advertising
  • Feedback form

©Copyright 2022 The American Association for the Surgery of Trauma