1273: EXAMINING STRESS ULCER PROPHYLAXIS PRACTICES AT A LEVEL I TRAUMA CENTER

Abstract

Introduction: Traumatic brain injury (TBI) and spinal cord injury (SCI) patients have a high risk for developing stress ulcers, which are associated with increased rates of complications and mortality. Though stress ulcer prophylaxis (SUP) may reduce the risk of stress ulcers among some patients, SUP administration is inconsistent across studies. The purpose of the study was to examine SUP practices and stress ulcer rates among neurocritical trauma patients. Methods: This was a single-center, retrospective, observational study conducted at a Level 1 trauma center and included adult (≥18 years) patients admitted to the intensive care unit (ICU) with a moderate or severe TBI or SCI. The primary outcome was to describe SUP administration practices. Secondary outcomes included the rate of clinically significant gastrointestinal bleeds (CSGBs) and pneumonia. Descriptive statistics were utilized to evaluate results by patients who received SUP versus patients who did not receive SUP. Results: A total of 133 patients were included. The median (interquartile range) age was 41 (31-59) years old, 82% were male, and 80% were TBI patients. Overall, 60% received SUP; 81% received an H2 receptor antagonist and 19% received a proton pump inhibitor. The median (IQR) time to administration of SUP was 7.0 (2.0-16.0) hours and duration of treatment was 2.4 (1.0-7.0) days. Patients who received SUP had a significantly higher median injury severity score (25.5 (16-38) vs. 20 (13-25) p=0.003) and a lower arrival Glasgow Coma score (5.0 (3.0-9.0) vs. 14 (9-15), p< 0.001). Additionally, patients receiving SUP had a significantly longer median ICU length of stay (9.0 (4.5-19.5 vs. 3 (2-7), p< 0.001), more were on mechanical ventilation (68 (85%) vs. 15 (28%), p< 0.001), and more developed pneumonia (19 (24%) vs. 2 (4%), p=0.002). Only one patient who was receiving SUP experienced a CSGB. Conclusions: This data suggests that administration practices for SUP are inconsistent and stress ulcers are rare in this patient population. Patients who received SUP were typically severe TBI patients who spent significantly more time in the ICU on mechanical ventilation and developed more complications. Due to the low rate of CSGB, further investigation is warranted to elucidate the risk-benefit ratio of SUP in this patient population.