Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study

Adrian W Ong,Laurel A Omert,Diane Vido,Brian M Goodman,Elan Jeremitsky,Aurelio Rodriguez,Jack Protetch

doi:10.1186/cc8054

Abstract

IntroductionProlonged intensive care unit lengths of stay (ICU LOS) for critical illness can have acceptable mortality rates and quality of life despite significant costs. Only a few studies have specifically addressed prolonged ICU LOS after trauma. Our goals were to examine characteristics and outcomes of trauma patients with LOS ≥ 30 days, predictors of prolonged stay and mortality.MethodsAll trauma ICU admissions over a seven-year period in a level 1 trauma center were analyzed. Admission characteristics, pre-existing conditions and acquired complications in the ICU were recorded. Logistic regression was used to identify independent predictors of prolonged LOS and predictors of mortality among those with prolonged LOS after univariate analyses.ResultsOf 4920 ICU admissions, 205 (4%) had ICU LOS >30 days. These patients were older and more severely injured. Age and injury severity score (ISS) were associated with prolonged LOS. After logistic regression analysis, sepsis, acute respiratory distress syndrome, and several infectious complications were important independent predictors of prolonged LOS. Within the group with ICU LOS >30 days, predictors of mortality were age, pre-existing renal disease as well as the development of renal failure requiring dialysis. Overall mortality was 12%.ConclusionsThe majority of patients with ICU LOS ≥ 30 days will survive their hospitalization. Infectious and pulmonary complications were predictors of prolonged stay. Further efforts targeting prevention of these complications are warranted.

Highlights

Prolonged intensive care unit lengths of stay (ICU LOS) for critical illness can have acceptable mortality rates and quality of life despite significant costs
Based on previous studies of medical and surgical ICU patients, our hypotheses were that age and injury severity predicted prolonged ICU LOS in trauma patients admitted to the ICU, but that the majority of trauma patients who survived beyond 30 days in the ICU would survive to discharge
Comparison of ICU LOS of 30 days or greater (ILOS>30) and ILOS

Summary

Introduction

Prolonged intensive care unit lengths of stay (ICU LOS) for critical illness can have acceptable mortality rates and quality of life despite significant costs. A few studies have addressed prolonged ICU LOS after trauma. Our goals were to examine characteristics and outcomes of trauma patients with LOS ≥ 30 days, predictors of prolonged stay and mortality. Prolonged intensive care unit (ICU) stays for critical illness can result in acceptable mortality rates and quality of life despite significant costs [1,2]. A few studies have addressed prolonged ICU lengths of stay (LOS) after trauma [3,4,5]. Our goals were to determine the outcomes and characteristics of trauma patients with prolonged ICU LOS. Based on previous studies of medical and surgical ICU patients, our hypotheses were that age and injury severity predicted prolonged ICU LOS in trauma patients admitted to the ICU, but that the majority of trauma patients who survived beyond 30 days in the ICU would survive to discharge

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