Background
Prolonged intensive care unit length of stay (ICU-LOS) is associated with high mortality
for medical and surgical patients. Existing literature suggests that this may not
be true for trauma patients. The objective of this study was to determine mortality
associated with varying ICU-LOS among trauma patients and to assess for independent
predictors of mortality.
Methods
Adult ICU patients (16–64 years) in the National Trauma Data Bank (2007–2012) were
categorized by ICU-LOS: 1, 2–9, 10–40, and >40 days (determined based on inflection
points). Multivariable logistic regression was used to determine associations with
mortality for each. Models accounted for clustering of patients within hospitals and
potential confounding associated with: age, gender, race/ethnicity, insurance status,
Injury Severity Score, blunt/penetrating injury, Glasgow Coma Scale, in-hospital complications,
ventilator dependency, and emergency department disposition.
Results
Among the 596,598 patients included, 6.5% (n = 38,812) died. Mortality varied with ICU-LOS: 9.9%, 4.9%, 6.6%, and 9.8%. Age >35 years
was a significant predictor of mortality in each. Injury Severity Score and the Glasgow
Coma Scale independently predicted mortality in patients with LOS ≤40 days as did
penetrating injuries, cardiac arrest, and renal failure. Identification with non-Hispanic
black race/ethnicity was also consistently significant. Once patients survived 9 days,
mortality steadily decreased, remaining relatively stable until 40 days. Thereafter,
trauma patients continued to demonstrate high survival with >87% remaining alive in
the ICU >90 days.
Conclusion
The results reveal that in contrast to expectations of high mortality associated with
prolonged ICU-LOS, critically injured adult trauma patients who do not die within
the first few days demonstrate an enhanced ability to survive, with an overall survival
of >92% and maintained at >85% among extreme ICU-LOS (>40 days). The data advocate
the utility of aggressive critical-care support for trauma patients, irrespective
of duration of ICU stay.
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Article info
Publication history
Published online: June 03, 2016
Accepted:
April 21,
2016
Footnotes
Adil H. Haider is the Primary Investigator of a contract (AD-1306-03980) from the Patient-Centered Outcomes Research Institute titled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED” and the recipient of a Harvard Surgery Affinity Research Collaborative Program Grant titled “Mitigating Disparities Through Enhancing Surgeons' Ability To Provide Culturally Relevant Care.”
The authors declare no sources of funding or conflicts of interest relevant to the analysis to report. Adil H. Haider is the cofounder of and an equity holder in Patient Doctor Technologies Inc, which owns and operates the website www.doctella.com.
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© 2016 Elsevier Inc. All rights reserved.
