Lee Yongwoong, Kang Byung Hee
Division of Trauma Surgery, Armed Forces Capital Hospital, Seongnam, Korea.
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Acute Crit Care. 2024 Nov;39(4):583-592. doi: 10.4266/acc.2024.00584. Epub 2024 Nov 22.
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13-35] vs. 45 days [28-67], P<0.001), total ICU stay (5 days [3- 11] vs. 17 days [9-35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62-11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06-5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08-2.81, P=0.023) were most highly related with UIR.
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.
在创伤患者中，非计划重症监护病房（ICU）再入院（UIR）与不良临床结局相关。在本研究中，我们旨在分析创伤患者UIR的相关因素。
本回顾性研究针对2016年1月至2022年12月在一家创伤中心ICU住院的创伤患者进行。收集入院时、首次ICU住院、首次从ICU出院时的临床信息以及再入院原因。将成功从ICU出院的患者与UIR患者进行比较。进行逻辑回归以确定对ICU再入院有显著影响的因素。
7年间共有5529例患者入住ICU，其中212例（3.8%）发生UIR。在发生UIR的患者中，9例（4.2%）死亡。UIR患者的住院时间（20天[四分位间距，13 - 35]对45天[28 - 67]，P<0.001）、总ICU住院时间（5天[3 - 11]对17天[9 - 35]，P<0.001）以及首次ICU住院期间的并发症显著更高。UIR最常见的原因是呼吸问题（53.8%）。在多变量分析中，首次ICU住院期间进行颈椎手术（比值比，6.56；95%置信区间，3.62 - 11.91；P<0.001）、肾脏替代治疗（RRT；3.52，2.06 - 5.99，P<0.001）和大量输血方案（MTP；1.74，1.08 - 2.81，P = 0.023）与UIR相关性最高。
由于UIR患者结局不佳，接受颈椎手术、RRT或MTP的创伤患者在普通病房需要监测，尤其是呼吸问题。
