(1725) Risk Factors and Clinical Outcome Differences of Unplanned ICU Admissions Among Trauma Patients

Introduction: Unplanned ICU admission (UA) rates are a recognized benchmark used for performance improvement in trauma centers. In this study we will ascertain what risk factors are associated with UA and to what degree the outcome of UA is different from that of planned ICU admission (PA).

Methods: We performed a retrospective analysis of trauma patients (age ≥21) between 1/1/2020 and 12/31/2023 at a level one trauma center. Registry data was queried for patient characteristics, injury types and severity, post ED disposition, complications, and outcome measures. Patients were divided in 3 groups: PA, UA, and acute ward admissions (WA). To elucidate risk factors for UA, we compared patients and injury characteristics, ED disposition and complications of UA and WA groups. To assess outcome differences, we compared the UA and PA groups. Univariate and multiple logistic regression (MLR) were performed. A p value of < 0.05 was used for statistical significance.

Results: Of the 5864 trauma patients studied WA, PA, and UA represented 86%, 11% and 3% of admissions, respectively. UA represented 21% of the 815 ICU admissions, and 14% of the 302 deaths. When compared to WA, UA was found to be associated to Hypotension, ISS>15, Head maximum AIS3+ (MAIS3), Chest MAIS3+, age >54, BAL < 80, Alcoholism, Dependent Care, Anticoagulation, CHF, COPD, DM, HTN, PAD, and Renal Failure, and ED to step down unit, ICU and OR disposition. Complications associated with UA were ETOH Withdrawal (1.0% vs 6.9%), Cardiac Arrest w/ CPR (0.3% vs 6.9%), Delirium (3.2% vs 9.8%), Sepsis (0.2% vs 6.4%), Unplanned Intubation (0.1% vs 39.3%), and Unplanned OR (1.0% vs 15.6%). UA when compared to PA showed an association with longer hospital and ICU LOS, but similar mortality (27.1% and 24.3%, respectively) despite of a lower ISS. MLR adjusting for age, ISS, race and revised trauma score, revealed no association between UA and mortality.

Conclusions: UA patients are a small fraction of the total trauma admissions representing an important share of ICU admissions. UA are responsible for a significant proportion of the trauma morbidity and mortality, and are linked to prolonged LOS and ICU LOS. Even though UA is linked to multiple risk factors, prevention and early rescue of the associated complications will likely reduce UA frequency and impact.