成熟创伤体系中 ICU 反弹的结果与预测因素分析。
An analysis of outcomes and predictors of intensive care unit bouncebacks in a mature trauma system.
机构信息
From the Trauma Services (E.H.B., S.J., M.A.H., M.M., T.M.V., B.W.G., J.A.M., D.V.N., F.B.R.), Penn Medicine Lancaster General Health, Lancaster, Pennsylvania; University of Texas Health Science Center at Tyler (A.D.C), UT Health East Texas, Tyler, TX; and Department of Trauma and Surgical Critical Care (P.K.K.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2020 Apr;88(4):486-490. doi: 10.1097/TA.0000000000002550.
BACKGROUND
With the recent birth of the Pennsylvania TQIP Collaborative, statewide data identified unplanned admissions to the intensive care unit (ICU) as an overarching issue plaguing the state trauma community. To better understand the impact of this unique population, we sought to determine the effect of unplanned ICU admission/readmission on mortality to identify potential predictors of this population. We hypothesized that ICU bounceback (ICUBB) patients would experience increased mortality compared with non-ICUBB controls and would likely be associated with specific patterns of complications.
METHODS
The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2012 to 2015 for all ICU admissions. Unadjusted mortality rates were compared between ICUBB and non-ICUBB counterparts. Multilevel mixed-effects logistic regression models assessed the adjusted impact of ICUBB on mortality and the adjusted predictive impact of 8 complications on ICUBB.
RESULTS
A total of 58,013 ICU admissions were identified from 2012 to 2015. From these, 53,715 survived their ICU index admission. The ICUBB rate was determined to be 3.82% (2,054/53,715). Compared with the non-ICUBB population, ICUBB patients had a significantly higher mortality rate (12% vs. 8%; p < 0.001). In adjusted analysis, ICUBB was associated with a 70% increased odds ratio for mortality (adjusted odds ratio, 1.70; 95% confidence interval, 1.44-2.00; p < 0.001). Adjusted analysis of predictive variables revealed unplanned intubation, sepsis, and pulmonary embolism as the strongest predictors of ICUBB.
CONCLUSION
Intensive care unit bouncebacks are associated with worse outcomes and are disproportionately burdened by respiratory complications. These findings emphasize the importance of the TQIP Collaborative in identifying statewide issues in need of performance improvement within mature trauma systems.
LEVEL OF EVIDENCE
Epidemiological study, level III.
背景
随着宾夕法尼亚州 TQIP 合作组织的成立，全州范围内的数据表明，计划外转入重症监护病房（ICU）是困扰该州创伤社区的一个首要问题。为了更好地了解这一独特人群的情况，我们试图确定计划外 ICU 入院/再入院对死亡率的影响，以确定该人群的潜在预测因素。我们假设 ICU 反弹（ICUBB）患者的死亡率会高于非 ICUBB 对照组，并且可能与特定的并发症模式有关。
方法
从 2012 年到 2015 年，我们对宾夕法尼亚州创伤结局研究数据库进行了回顾性查询，以获取所有 ICU 入院患者的信息。比较了 ICUBB 患者和非 ICUBB 患者的未调整死亡率。多水平混合效应逻辑回归模型评估了 ICUBB 对死亡率的调整影响以及 8 种并发症对 ICUBB 的调整预测影响。
结果
2012 年至 2015 年期间，共确定了 58013 例 ICU 入院患者。在这些患者中，有 53715 例患者在 ICU 指数入院时存活。ICUBB 发生率为 3.82%（2054/53715）。与非 ICUBB 人群相比，ICUBB 患者的死亡率明显更高（12%比 8%；p<0.001）。在调整分析中，ICUBB 与死亡率增加 70%的比值比相关（调整比值比，1.70；95%置信区间，1.44-2.00；p<0.001）。对预测变量的调整分析显示，计划外插管、败血症和肺栓塞是 ICUBB 的最强预测因素。
结论
ICU 反弹与较差的预后相关，并且不成比例地受到呼吸系统并发症的困扰。这些发现强调了 TQIP 合作组织在识别全州范围内需要改进绩效的问题方面的重要性，这些问题在成熟的创伤系统中存在。
证据水平
流行病学研究，三级。
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