Admission of elderly blunt thoracic trauma patients directly to the intensive care unit improves outcomes

Abstract

IntroductionBlunt thoracic trauma in the elderly has been associated with adverse outcomes. As an internal quality improvement initiative, direct intensive care unit (ICU) admission of nonmechanically ventilated elderly patients with clinically important thoracic trauma (primarily multiple rib fractures) was recommended. MethodsA retrospective review of the trauma registry at a level 1 trauma center was performed for patients aged ≥65 y with blunt thoracic trauma, admitted between the 2 y before (2010-2012) and after (2013-2015) the recommendation. ResultsThere were 258 elderly thoracic trauma admissions post-recommendation (POST) and 131 admissions pre-recommendation (PRE). Their median Injury Severity Score (13 versus 12, P = ns) was similar. The POST group had increased ICU utilization (54.3% versus 25.2%, P < 0.001). The POST group had decreased unplanned ICU admissions (8.5% versus 13.0%, P < 0.001), complications (14.3% versus 28.2%, P = 0.001), and ICU length of stay (4 versus 6 d, P = 0.05). More POST group patients were discharged to home (41.1% versus 27.5%, P = 0.008). Of these, the 140 POST and 33 PRE patients admitted to the ICU had comparable median Injury Severity Score (14 versus 17, P = ns) and chest Abbreviated Injury Score ≥3 (66.4% versus 60.6%, P = ns). The POST-ICU group redemonstrated the above benefits, as well as decreased hospital length of stay (10 versus 14 d, P = 0.03) and in-hospital mortality (2.9% versus 15.2%, P = 0.004). ConclusionsAdmission of geriatric trauma patients with clinically important blunt thoracic trauma directly to the ICU was associated with improved outcomes.