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Open Access

Delay in ICU transfer is protective against ICU readmission in trauma patients: a naturally controlled experiment

Stephen E Ranney, Stas Amato, Peter Callas, Lloyd Patashnick, Tim H Lee, Gary C An, Ajai K Malhotra
DOI: 10.1136/tsaco-2021-000695 Published 17 February 2021
Stephen E Ranney
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Stas Amato
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Peter Callas
2Mathematics, University of Vermont, Burlington, Vermont, USA
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Lloyd Patashnick
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Tim H Lee
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Gary C An
1Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont, USA
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Ajai K Malhotra
3Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
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    Figure 1

    Mortality in trauma patients admitted to the intensive care unit grouped by age showing a significant increase with age beginning in the 6th decade of life.

  • Figure 2
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    Figure 2

    Forest plot of the OR for mortality based on age, Charlson Comorbidity Index (CCI), Injury Severity Score (ISS), Delayed intensive care unit (ICU) discharge for all patients (circle) and for the high mortality risk subset (age ≥50, diamond). *Represents statistical significance with p<0.05.

Tables

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  • Table 1

    Patient demographics, comorbidities, injury burden and patterns, and hospital outcomes of the study population (all patients) and comparisons of patient cohorts experiencing ICUbb (ICUbb+) to those that did not (ICUbb−)

    All patients
    (n=2004)
    ICUbb−
    (n=1891)
    ICUbb+
    (n=113)
    P value
    Mean±SD age (years)52±2352±2364±18<0.01
    % male (n)64 (1274)63 (1199)66 (75)0.52
    Median CCI score (IQR)1 (0, 3)1 (0, 3)3 (1, 5)<0.01
    % CCI score ≥5 (n)14 (281)13.3 (252)25.7 (29)<0.01
    Significant injury (AIS score ≥2)%n%n%nP value
     Head50.7101550.795846570.96
     Face119119000.28
     Neck1.7341.8330.910.49
     Thorax26.953926.550133.6380.1
     Abdomen1326113.3252890.1
     Spine81617.614315.918<0.01
     Extremity—upper1.6311.5291.820.84
     Extremity—lower13.32671324618.6210.09
     External soft tissue/burn1200.9163.54<0.01
    Median ISS (IQR)17 (10, 24)17 (10, 24)19 (16, 26)<0.01
    % ISS >25 (n)454 (22.7)21.9 (414)35.4 (40)0.01
    Median (IQR) ICU LOS (days)3 (2, 5)3 (2, 5)11 (6, 18)<0.01
    Median (IQR) SD HLOS (days)6 (3, 12)6 (3, 11)19 (11, 32)<0.01
    % mortality (n)3.6 (72)2.6 (49)20.4 (23)<0.01
    • AIS, Abbreviated Injury Scale; CCI, Charlson Comorbidity Index; HLOS, hospital length of stay; ICUbb, intensive care unit bounce back; ISS, Injury Severity Score; LOS, length of stay.

  • Table 2

    OR with 95% CIs of factors that are independently associated with mortality

    OR (95% CI)P value
    Age1.06 (1.04 to 1.08)<0.01
    CCI1.01 (0.92 to 1.11)0.87
    ISS1.05 (1.02 to 1.08)<0.01
    ICUbb6.73 (3.80 to 11.91)<0.01
    • CCI, Charlson Comorbidity Index; ICUbb, intensive care unit bounce back; ISS, Injury Severity Score.

  • Table 3

    Presentation demographics, comorbidities, injury burden, and outcome data of the Early vs. Delayed cohorts

    Early
    (n=1690)
    Delayed
    (n=314)
    P value
    Mean±SD age (years)52±2355±220.01
    % male (n)63 (1066)66 (208)0.28
    Median CCI score (IQR)1 (0, 3)2 (1, 3)<0.01
    % CCI score ≥5 (n)13.8 (233)15.3 (48)0.48
    Median ISS (IQR)17 (10, 24)17 (13, 25)<0.01
    % ISS >25 (n)21.7 (367)27.7 (87)0.07
    Median (IQR) ICU LOS (days)2 (2, 4)5 (3, 8)<0.01
    Median (IQR) SD HLOS (days)6 (3, 11)10 (6, 18)<0.01
    Rate of ICUbb (%)6.5 (109)1.3 (4)<0.01
    % mortality* (n)3.9 (65)2.2 (7)0.16
    • *Includes discharged to hospice.

    • CCI, Charlson Comorbidity Index; HLOS, hospital length of stay; ICUbb, intensive care unit bounce back; ISS, Injury Severity Score; LOS, length of stay.

  • Table 4

    Logistic regression models evaluating the OR of ICUbb based on age, ISS, CCI score, and Delayed ICU transfer

    OR (95% CI)P value
    Age1.02 (1.01 to 1.03)<0.01
    ISS1.05 (1.03 to 1.07)<0.01
    CCI1.12 (1.04 to 1.20)<0.01
    Delayed transfer0.16 (0.06 to 0.44)<0.01
    • CCI, Charlson Comorbidity Index; ICUbb, intensive care unit bounce back; ISS, Injury Severity Score.

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Delay in ICU transfer is protective against ICU readmission in trauma patients: a naturally controlled experiment
Stephen E Ranney, Stas Amato, Peter Callas, Lloyd Patashnick, Tim H Lee, Gary C An, Ajai K Malhotra
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000695; DOI: 10.1136/tsaco-2021-000695

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Delay in ICU transfer is protective against ICU readmission in trauma patients: a naturally controlled experiment
Stephen E Ranney, Stas Amato, Peter Callas, Lloyd Patashnick, Tim H Lee, Gary C An, Ajai K Malhotra
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000695; DOI: 10.1136/tsaco-2021-000695
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Delay in ICU transfer is protective against ICU readmission in trauma patients: a naturally controlled experiment
Stephen E Ranney, Stas Amato, Peter Callas, Lloyd Patashnick, Tim H Lee, Gary C An, Ajai K Malhotra
Trauma Surgery & Acute Care Open Feb 2021, 6 (1) e000695; DOI: 10.1136/tsaco-2021-000695
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