Fokin Alexander A, Wycech Knight Joanna, Gallagher Phoebe K, Xie Justin Fengyuan, Brinton Kyler C, Tharp Madison E, Puente Ivan
Department of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.
Department of Surgery, Florida Atlantic University Charles E Schmidt College of Medicine, Boca Raton, FL 33431, United States.
World J Crit Care Med. 2025 Jun 9;14(2):101957. doi: 10.5492/wjccm.v14.i2.101957.
The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit (ICU) is an unanticipated event with possible life-threatening consequences. Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality. Two different types of unplanned ICU admissions include upgrades (patients admitted to the floor then moved to the ICU) and bounce backs (patients admitted to the ICU, discharged to the floor, and then readmitted to the ICU). Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.
To analyze the characteristics, management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.
This institutional review board approved, retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period (2017-2023). This included 134 upgrades and 69 bounce backs. Analyzed variables included: (1) Age; (2) Sex; (3) Comorbidities; (4) Mechanism of injury (MOI); (5) Injury severity score (ISS); (6) Glasgow Coma Scale (GCS); (7) Type of injury; (8) Transfusions; (9) Consultations; (10) Timing and reason for unplanned admission; (11) Intubations; (12) Surgical interventions; (13) ICU and hospital lengths of stay; and (14) Mortality.
Unplanned ICU admissions comprised 4.2% of total ICU admissions. Main MOI was falls. Mean age was 70.7 years, ISS was 12.8 and GCS was 13.9. Main injuries were traumatic brain injury (37.4%) and thoracic injury (21.7%), and main reason for unplanned ICU admission was respiratory complication (39.4%). The 47.3% underwent a surgical procedure and 46.8% were intubated. Average timing for unplanned ICU admission was 2.9 days. Bounce backs occurred half as often as upgrades, however had higher rates of transfusions (63.8% 40.3%, = 0.002), consultations (4.8 3.0, < 0.001), intubations (63.8% 38.1%%, = 0.001), longer ICU lengths of stay (13.2 days 6.4 days, < 0.001) and hospital lengths of stay (26.7 days 13.0 days, < 0.001). Mortality was 25.6% among unplanned ICU admissions, 31.9% among geriatric unplanned ICU admissions and 11.9% among all trauma ICU patients.
Unplanned ICU admissions constituted 4.2% of total ICU admissions. Respiratory complications were the main cause of unplanned ICU admissions. Bounce backs occurred half as often as upgrades, but were associated with worse outcomes.
将住院创伤患者从普通病房紧急升级到创伤重症监护病房（ICU）是一个意外事件，可能会带来危及生命的后果。非计划入住ICU与发病率和死亡率增加相关，是创伤服务质量的一个指标。两种不同类型的非计划入住ICU包括升级（先入住普通病房然后转至ICU的患者）和反弹（先入住ICU，出院至普通病房，然后再次入住ICU的患者）。先前的研究表明，老年创伤患者出现不良结局的风险更高。
分析住院期间非计划入住ICU的创伤患者的特征、管理及结局。
这项经机构审查委员会批准的回顾性队列研究，对一家城市一级创伤中心在六年期间（2017 - 2023年）203例非计划入住ICU的成年创伤患者进行了检查。其中包括134例升级患者和69例反弹患者。分析的变量包括：（1）年龄；（2）性别；（3）合并症；（4）损伤机制（MOI）；（5）损伤严重程度评分（ISS）；（6）格拉斯哥昏迷量表（GCS）；（7）损伤类型；（8）输血情况；（9）会诊情况；（10）非计划入住的时间和原因；（11）插管情况；（12）手术干预；（13）ICU住院时间和住院总时长；以及（14）死亡率。
非计划入住ICU的患者占ICU总入院人数的4.2%。主要损伤机制是跌倒。平均年龄为70.7岁，ISS为12.8，GCS为13.9。主要损伤为创伤性脑损伤（37.4%）和胸部损伤（21.7%），非计划入住ICU的主要原因是呼吸并发症（39.4%）。47.3%的患者接受了外科手术，46.8%的患者进行了插管。非计划入住ICU的平均时间为2.9天。反弹患者的发生频率是升级患者的一半，然而输血率更高（63.8%对40.3%，P = 0.002）、会诊率更高（4.8对3.0，P < 0.001）、插管率更高（63.8%对38.1%，P = 0.001）、ICU住院时间更长（13.2天对6.4天，P < 0.001）以及住院总时长更长（26.7天对13.0天，P < 0.001）。非计划入住ICU患者的死亡率为25.6%，老年非计划入住ICU患者的死亡率为31.9%，所有创伤ICU患者的死亡率为11.9%。
非计划入住ICU的患者占ICU总入院人数的4.2%。呼吸并发症是非计划入住ICU的主要原因。反弹患者的发生频率是升级患者的一半，但结局更差。
