Variation in intensive care unit utilization and mortality after blunt splenic injury

Abstract 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...

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Bibliographic Details
Published in:The Journal of surgical research 2016-06, Vol.203 (2), p.338-347
Main Authors: Kaufman, Elinore J., MD, Wiebe, Douglas J., PhD, Martin, Niels D., MD, FACS, FCCM, Pascual, Jose L., MD, Reilly, Patrick M., MD, FCCP, FACS, Holena, Daniel N., MD
Format: Article
Language:English
Subjects:
Adult
Blunt splenic injury
Critical Care - statistics & numerical data
Critical Care - utilization
Female
Humans
ICU utilization
Injury Severity Score
Intensive Care Units - statistics & numerical data
Intensive Care Units - utilization
Logistic Models
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Admission - standards
Pennsylvania
Registries
Retrospective Studies
Risk Adjustment
Spleen - injuries
Surgery
Trauma Centers - statistics & numerical data
Trauma outcomes
Wounds, Nonpenetrating - mortality
Wounds, Nonpenetrating - therapy
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Summary:Abstract 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  
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2016.03.049