Goins W A, Reynolds H N, Nyanjom D, Dunham C M
Department of Surgery, Maryland Institute for Emergency Medical Services Systems, Baltimore.
Crit Care Med. 1991 Mar;19(3):339-45. doi: 10.1097/00003246-199103000-00010.
To describe the hospital course and outcomes of trauma patients requiring ICU stays greater than 30 days and the charges they incur.
A retrospective case series analysis of data collected from patient charts and trauma registry.
A Level I regional trauma center that is part of a statewide trauma system.
Over a 3-yr period, 87 patients (3% of all trauma ICU admissions) had prolonged stays (greater than 30 days) in the ICU; they constitute the study group. Blunt trauma was responsible for 90% of injuries, and the mean Injury Severity Score was 34 +/- 16 SD.
Mechanical ventilation was required for 78.5% of the time spent in the ICU. The mean time spent on mechanical ventilators was 47 +/- 23 days; in the ICU, 60 +/- 27 days; and in the hospital, 72 +/- 29 days. Infectious complications occurred in 90% and organ dysfunction was seen in 76% of patients. The overall mortality rate was 17.2% (31% for patients greater than 65 yr). Patients less than 40 yr had lower mortality rates despite a significantly higher Injury Severity Score and lower Glasgow Coma Scale score compared with those greater than 65 yr. More patients greater than 65 yr were discharged to chronic care facilities than those younger (23% vs. 5%). The number of patients followed at 3 and 12 months after discharge was 74% and 54%, respectively, with only two deaths. The mean hospital and professional charges to the patients were $101,000 +/- 61,000 and $35,000 +/- 13,000, respectively.
Length of ICU stay was most closely associated with the need for mechanical ventilation. The presence of premorbid illness, age greater than 65 yr, and organ dysfunction was associated with increased mortality. Although trauma patients requiring prolonged ICU stays utilize many resources, the ultimate outcome may be fairly good.
描述在重症监护病房（ICU）住院时间超过30天的创伤患者的住院过程、结局及其产生的费用。
对从患者病历和创伤登记处收集的数据进行回顾性病例系列分析。
作为全州创伤系统一部分的一级区域创伤中心。
在3年期间，87例患者（占所有创伤ICU入院患者的3%）在ICU住院时间延长（超过30天）；他们构成研究组。钝性创伤占损伤的90%，平均损伤严重度评分是34±16标准差。
在ICU期间，78.5%的时间需要机械通气。机械通气的平均时间为47±23天；在ICU为60±27天；在医院为72±29天。90%的患者发生感染性并发症，76%的患者出现器官功能障碍。总体死亡率为17.2%（65岁以上患者为31%）。尽管与65岁以上患者相比，40岁以下患者的损伤严重度评分显著更高且格拉斯哥昏迷量表评分更低，但死亡率更低。65岁以上出院转至慢性护理机构的患者比年轻患者更多（23%对5%）。出院后3个月和12个月随访的患者数量分别为74%和54%，仅有2例死亡。患者的平均住院费用和专业费用分别为101,000±61,000美元和35,000±13,000美元。
ICU住院时间与机械通气需求最密切相关。存在病前疾病、年龄大于65岁和器官功能障碍与死亡率增加相关。尽管需要长时间入住ICU的创伤患者使用了许多资源，但最终结局可能相当不错。
