Article Figures & Data
Tables
- Table 1
Baseline of trauma admissions at the intermediate and intensive care units
Total, n=1320 IMCU, n=675 ICU, 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—HET 500 (37.9%) 251 (37.2%) 0 (0.0%) 249 (38.6%) 0 (0.0%) Traffic—LET 130 (9.8%) 57 (8.4%) 73 (11.3%) Fall—HET 136 (10.3%) 76 (11.3%) 60 (9.3%) Fall—LET 373 (28.3%) 207 (30.7%) 166 (25.7%) Penetrating—firearms 21 (1.6%) 7 (1.0%) 14 (2.2%) Penetrating—other 59 (4.5%) 36 (5.3%) 23 (3.6%) Drowning 5 (0.4%) 0 (0.0%) 5 (0.8%) Burn/inhalation trauma 31 (2.3%) 14 (2.1%) 17 (2.6%) Other 65 (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 (%) ≤3 551 (41.7%) 332 (49.2%) 0 (0.0%) 219 (34.0%) 0 (0.0%) 4 543 (41.1%) 288 (42.7%) 255 (39.5%) 5–6 226 (17.1%) 55 (8.1%) 171 (26.5%) Head injury severity First ED GCS score 14–15 666 (54.6%) 528 (78.2%) 53 (7.9%) 138 (21.4%) 47 (7.3%) 9–12 152 (12.5%) 75 (11.1%) 77 (11.9%) ≤8 402 (33.0%) 19 (2.8%) 383 (59.4%) Maximum head AIS score ≤2 626 (47.4%) 366 (54.2%) 0 (0.0%) 260 (40.3%) 0 (0.0%) 3 160 (12.1%) 84 (12.4%) 76 (11.8%) 4–6 534 (40.5%) 225 (33.3%) 309 (47.9%) Thoracoabdominal injury severity Maximum thorax AIS score ≤2 843 (63.9%) 439 (65.0%) 0 (0.0%) 404 (62.6%) 0 (0.0%) 3 260 (19.7%) 135 (20.0%) 125 (19.4%) 4–6 217 (16.4%) 101 (15.0%) 116 (18.0%) Maximum abdominal AIS score ≤2 1222 (92.6%) 634 (93.9%) 0 (0.0%) 588 (91.2%) 0 (0.0%) 3 60 (4.5%) 28 (4.1%) 32 (5.0%) 4–5 38 (2.9%) 13 (1.9%) 25 (3.9%) Extremity injury severity Maximum extremity AIS score ≤2 1108 (83.9%) 570 (84.4%) 0 (0.0%) 538 (83.4%) 0 (0.0%) 3 195 (14.8%) 97 (14.4%) 98 (15.2%) 4–5 17 (1.3%) 8 (1.2%) 9 (1.4%) Vital signs at presentation (SD) (IQR) Systolic blood pressure 135 (28.5) 137 (24.6) 29 (4.3%) 133 (32.1) 31 (4.8%) Respiratory rate 19 (5.9) 19 (5.3) 123 (18.2%) 18 (6.6) 156 (24.2%) Saturation 1.00 (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) Hemoglobin 8.5 (1.2) 8.6 (1.0) 38 (5.6%) 8.3 (1.4) 46 (7.1%) Lactate 2.2 (1.5–3.3) 2 (1.4–2.8) 208 (30.8%) 2.6 (1.7–3.9) 135 (20.9%) pH 7.4 (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%) Saturation 1.00 (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=324 Surgical 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—HET 82 (25.3%) 0 (0.0%) 169 (48.1%) 0 (0.0%) Traffic—LET 43 (13.3%) 14 (4.0%) Fall—HET 25 (7.7%) 51 (14.5%) Fall—LET 153 (47.2%) 54 (15.4%) Penetrating—firearms 1 (0.3%) 6 (1.7%) Penetrating—other 8 (2.5%) 28 (8.0%) Burn/inhalation trauma 0 (0.0%) 14 (4.0%) Other 12 (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 ≤3 107 (33.0%) 0 (0.0%) 225 (64.1%) 0 (0.0%) 4 178 (54.9%) 110 (31.3%) 5–6 39 (12.0%) 16 (4.6%) Head injury severity First ED GCS score 14–15 223 (68.8%) 25 (7.7%) 305 (86.9%) 28 (8.0%) 9–12 62 (19.1%) 13 (3.7%) ≤8 14 (4.3%) 5 (1.4%) Maximum head AIS score ≤2 72 (22.2%) 0 (0.0%) 294 (83.8%) 0 (0.0%) 3 50 (15.4%) 34 (9.7%) 4–6 202 (62.3%) 23 (6.6%) Thoracoabdominal injury severity Maximum thorax AIS score ≤2 273 (84.3%) 0 (0.0%) 166 (47.3%) 0 (0.0%) 3 32 (9.9%) 103 (29.3%) 4–6 19 (5.9%) 82 (23.4%) Maximum abdominal AIS score ≤2 322 (99.4%) 0 (0.0%) 312 (88.9%) 0 (0.0%) 3 2 (0.6%) 26 (7.4%) 4–5 0 (0.0%) 13 (3.7%) Extremity injury severity Maximum extremity AIS score ≤2 307 (94.8%) 0 (0.0%) 263 (74.9%) 0 (0.0%) 3 17 (5.2%) 80 (22.8%) 4–5 0 (0.0%) 8 (2.3%) Vital signs at presentation (SD)[IQR] Systolic blood pressure 139 (23.9) 20 (6.2%) 136 (25.2) 9 (2.6%) Respiratory rate 19 (5.3) 66 (20.4%) 19 (5.2) 57 (16.2%) Saturation 1.00 [0.97 to 1.00] 30 (9.3%) 1.00 [0.98 to 1.00] 12 [3.4%] Laboratory parameters at presentation (SD)[IQR] Hemoglobin 8.6 [8.5 to 8.7] 22 (6.8%) 8.7 [8.6 to 8.8] 16 (4.6%) Lactate 2.0 [1.5 to 2.9] 128 (39.5%) 1.9 [1.4 to 2.8] 80 (22.8%) pH 7.4 [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%) BE 0.0 [−3.0 to 2.0] 116 (35.8%) 0.0 [−2.0 to 2.0] 58 (16.5%) Saturation 1.00 [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
IMCU ICU Total admission, n n=675 n=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) Postoperative 20 (52.6) 10 10 Intubation due to respiratory deterioration 7 (1.04) 5 2 Intubation due to sepsis 2 (0.30) 1 1 Intubation for other reasons* 6 (0.89) 2 4 Respiratory support with non-invasive ventilation 2 (0.30) 1 1 Multiple vasopressive medication 1 (0.15) 1 0 *Atrial flutter, Guillain-Barré syndrome, combined respiratory and neurological deterioration, sedation to reduce the ICP, epileptic insult.
