Velez David R, Duncan Anthony J, Zreik Khaled
Department of General Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, USA.
Department of Trauma and Acute Care Surgery, Sanford Medical Center Fargo, Fargo, USA.
Cureus. 2024 Aug 1;16(8):e65957. doi: 10.7759/cureus.65957. eCollection 2024 Aug.
The utilization of healthcare services in a growing population has raised concerns about its impact on clinical outcomes. Studies have shown that increased hospital census is associated with higher admission rates and unnecessary consults, tests, and procedures in various areas of healthcare. Traumatic brain injuries (TBIs), a significant concern due to their potential for long-term disabilities, are commonly encountered in intensive care units (ICUs) and are a leading cause of patient mortality. Despite extensive research on various aspects of TBI, the effect of the patient census on TBI outcomes remains unexplored. This study aims to investigate the relationship between healthcare provider patient census and clinical outcomes in TBI patients at a level I trauma center.
A retrospective review was conducted from 2017 to 2022. The mean number of patients per day in the trauma service was determined, with patients below this average considered to be present on low-census days and those above it on high-census days. Patient demographics, mechanisms of injury, vital signs, TBI severity, and associated injuries were analyzed. Adjusted regression analyses were conducted.
Over the study period, 1,527 TBI patients were identified. Demographics were similar between patients admitted on high- and low-census days. Patients with moderate TBI were 30% less likely to be admitted to the ICU on high-census days, whereas there was no difference in ICU admission for patients with mild or severe TBI. Delirium was significantly higher in patients admitted on high-census days compared to those on low-census days. This was further identified to be predominantly driven by patients with mild TBI admitted on high-census days.
While most outcomes remained consistent, significant rates of delirium were found in our mild TBI patients admitted on high-census days suggesting the need for additional factors in the evaluation of these patients on admission. This study also reveals potential under-triage in moderate TBI patients on high-census days as they had significantly lower rates of ICU admission. These findings emphasize the need for further investigations to optimize patient care strategies within the context of fluctuating healthcare system demands.
在不断增长的人口中，医疗服务的利用引发了人们对其对临床结果影响的担忧。研究表明，医院人口普查增加与更高的入院率以及医疗保健各个领域不必要的会诊、检查和程序有关。创伤性脑损伤（TBI）因其可能导致长期残疾而备受关注，在重症监护病房（ICU）中很常见，并且是患者死亡的主要原因。尽管对TBI的各个方面进行了广泛研究，但患者普查对TBI结果的影响仍未得到探索。本研究旨在调查一级创伤中心医疗服务提供者的患者普查与TBI患者临床结果之间的关系。
对2017年至2022年进行回顾性研究。确定创伤服务中每天的平均患者数量，低于该平均值的患者被视为在低普查日就诊，高于该平均值的患者在高普查日就诊。分析患者的人口统计学特征、损伤机制、生命体征、TBI严重程度和相关损伤。进行了调整后的回归分析。
在研究期间，共识别出1527例TBI患者。高普查日和低普查日入院患者的人口统计学特征相似。中度TBI患者在高普查日入住ICU的可能性比低普查日低30%，而轻度或重度TBI患者的ICU入住率没有差异。高普查日入院的患者谵妄发生率明显高于低普查日入院的患者。进一步发现，这主要是由高普查日入院的轻度TBI患者导致的。
虽然大多数结果保持一致，但我们发现高普查日入院的轻度TBI患者谵妄发生率很高，这表明在评估这些患者入院时需要考虑其他因素。本研究还揭示了高普查日中度TBI患者可能存在分诊不足的情况，因为他们的ICU入住率明显较低。这些发现强调了需要进一步研究，以便在医疗系统需求波动的背景下优化患者护理策略。
