Unplanned Readmissions to the Intensive Care Unit Among Geriatric Trauma Patients

2021 ◽  
pp. 000313482110488
Author(s):  
Shana Santarelli ◽  
Madison E. Morgan ◽  
Tawnya Vernon ◽  
Eric Bradburn ◽  
Lindsey L. Perea
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Geriatric Trauma ◽  
Medical Community ◽  
Unplanned Readmission ◽  
Trauma Patients ◽  
Geriatric Population ◽  
Risk Of Mortality ◽  
Trauma Outcome ◽  
Study Database

Background Unplanned readmission/bounceback to the intensive care unit (ICUBB) is a prevalent issue in the medical community. The geriatric population is incompletely studied in regard to ICUBB. We sought to determine if ICUBB in older patients was associated with higher risk of mortality. We hypothesized that, of those who were older, those with ICUBB would have higher mortality compared to those with no ICUBB. Further, we hypothesized that of those with ICUBB, older age would lead to higher mortality. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003 to 2018 for all trauma patients of age ≥40 years. Those with advance directives were excluded. Adjusted analysis in the form of logistic regressions controlling for demographic and injury covariates and clustering by facility were used to assess the adjusted impact of ICUBB and age on mortality. Results 363,778 patients were aged ≥40 years. When comparing mortalities between the age 40 and 49 years group and those in older groups, a dramatic increase in mortality was observed between those in each respective age category with ICUBB vs non-ICUBB. This trend was most prominent in those in the 90+ years age group (ICUBB: AOR: 34.78, P < .001; non-ICUBB: AOR: 9.08, P < .001). A second model only including patients who had ICUBB found that patients of age ≥65 years had significantly higher odds of mortality (AOR: 4.10, P < .001) when compared to their younger counterparts (age <65 years). Discussion An ICUBB seems to exacerbate mortality rates as age increases. This profound increase in mortality calls for strategies to be developed, especially in the older population, to attempt to mitigate the factors leading to ICUBB.

scholarly journals Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal

2021 ◽  
pp. 219256822098070
Author(s):  
Gyanendra Shah ◽  
Gaurav Raj Dhakal ◽  
Anil Gupta ◽  
Pawan Kumar Hamal ◽  
Siddhartha Dhungana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Limited Resource ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Resource Setting ◽  
Cord Injury ◽  
Huge Impact

Study Design: Retrospective study. Objectives: Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). Methods: All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. Results: Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. Conclusions: Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.

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

2017 ◽  
Vol 219 ◽  
pp. 334-340 ◽  
Author(s):  
Owen J. Pyke ◽  
Jerry A. Rubano ◽  
James A. Vosswinkel ◽  
Jane E. McCormack ◽  
Emily C. Huang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Thoracic Trauma ◽  
Trauma Patients ◽  
Blunt Thoracic Trauma

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

scholarly journals Hypothermia as a predictor for mortality in trauma patients at admittance to the intensive care unit

2016 ◽  
Vol 9 (3) ◽  
pp. 97 ◽  
Author(s):  
Kirsten Balvers ◽  
Marjolein Van der Horst ◽  
Maarten Graumans ◽  
Christa Boer ◽  
JanM Binnekade ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Trauma Patients

Validation of a modified pediatric risk of mortality III model in a pediatric intensive care unit in Thailand

2018 ◽  
Vol 2 (4) ◽  
pp. 65 ◽  
Author(s):  
Kanokpan Ruangnapa ◽  
Sittikiat Sucheewakul ◽  
Tippawan Liabsuetrakul ◽  
Edward McNeil ◽  
Kantara Lim ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Risk Of Mortality

Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

2014 ◽  
Vol 80 (8) ◽  
pp. 778-782 ◽  
Author(s):  
A. Britton Christmas ◽  
Elizabeth Freeman ◽  
Angela Chisolm ◽  
Peter E. Fischer ◽  
Gaurav Sachdev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injuries ◽  
Injury Severity ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Respiratory Compromise ◽  
Patient Demographics ◽  
Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

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