Variation in intensive care unit utilization and mortality after blunt splenic injury. J Surg Res 2016 Jun 15;203(2):338-47
Date
07/02/2016Pubmed ID
27363642Pubmed Central ID
PMC4933327DOI
10.1016/j.jss.2016.03.049Scopus ID
2-s2.0-84969508635 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
BACKGROUND: Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission.
MATERIALS AND METHODS: We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers.
RESULTS: Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers.
CONCLUSIONS: Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality.
Author List
Kaufman EJ, Wiebe DJ, Martin ND, Pascual JL, Reilly PM, Holena DNAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCritical Care
Female
Humans
Injury Severity Score
Intensive Care Units
Logistic Models
Male
Middle Aged
Patient Admission
Pennsylvania
Registries
Retrospective Studies
Risk Adjustment
Spleen
Trauma Centers
Wounds, Nonpenetrating
