Retrospective Analysis of Unplanned ICU Admissions Among Adult Trauma Patients

Abstract

Background: Unplanned Intensive Care Unit (ICU) admissions are hospital-acquired events associated with increased risk of in-hospital mortality and greater length of stay.Purpose: The purpose of this Doctoral of Nursing Practice (DNP) project is to 1) identify the incidence of trauma patients with unplanned ICU admissions, and 2) describe characteristics among patients with unplanned ICU admissions, including activation level of the trauma team, patient demographics (e.g., Age), Glasgow Coma Scale, mean Injury Severity Score (ISS), pre-existing conditions, delirium, frailty, Emergency Department disposition, mean ICU length of stay, and mean ventilator days. Methods: A retrospective analysis using the National Trauma Database (NTDB) for unplanned ICU admissions was performed to describe characteristics of trauma patients with unplanned ICU admissions. Inclusion was limited to trauma patients with unplanned ICU admissions admitted to a large academic medical center in the Southwest region of the United States during August 1, 2019 and July 31, 2021. Results: During the two-year period, 109 adult trauma patients met the criteria for unplanned ICU admission. The 109 unplanned admissions were divided by the 5,713 total adult trauma admissions resulting in a 2% incidence. Among these trauma patients with unplanned ICU admissions, the mortality rate was 22.9%, and the average length of hospital stay was 18.5 days + 18.4 days (SD) (95% CI, 15.01 - 21.98 days). The median age of adult trauma patients with unplanned ICU admissions was 68 years (IQR [Q1 52, Q3 77]). The average ISS was 14.9 + 10.5 (SD), consistent with higher mortality risk from multiple traumatic injuries. A greater number of unplanned ICU transfers (n = 50) was identified when compared to ICU readmissions (n = 39). A majority (80%) of patients with unplanned ICU admissions had at least one comorbidity, with the average number of comorbidities per patient being three. Conclusions: The opportunity to prevent adverse outcomes, including unplanned transfer to the ICU, exists among adult trauma patients. Findings from this DNP project can help inform triaging of geriatric trauma patients and improve management of chronic diseases to prevent unplanned ICU admissions and hospital-acquired events.