Trauma ICU Prevalence Project: the diversity of surgical critical care. Issue 1 (18th February 2019)

• Record Type: Journal Article
• Authors: Michetti, Christopher P; Fakhry, Samir M; Brasel, Karen; Martin, Niels D; Teicher, Erik J; Newcomb, Anna
• Other Names: author non-byline.; Stewart Amy author non-byline.; Chang Grace author non-byline.; Foreman Michael author non-byline.; Rainey Evan Elizabeth author non-byline.; Moore Forrest O (Dell) author non-byline.; Huang Jessica author non-byline.; Kaups Krista author non-byline.; Dirks Rachel C author non-byline.; Sensenig Rachel L author non-byline.; Roman Janika L San author non-byline.; Burlew Clay Cothren author non-byline.; Campion Eric M author non-byline.; Weireter Len author non-byline.; Kelley Katherine author non-byline.; Kim Dennis author non-byline.; Howell Erin author non-byline.; Hu Charles author non-byline.; Lewandowski Karen author non-byline.; Michetti Christopher P author non-byline.; Liu Chang author non-byline.; Teicher Erik J author non-byline.; Dauer Elizabeth D author non-byline.; Mukherjee Kaushik author non-byline.; Penaloza Liz G author non-byline.; Cullinane Daniel C author non-byline.; Carrick Matthew M author non-byline.; Agrawal Vaidehi author non-byline.; Lorenzo Manuel author non-byline.; Ferrari-Light Dana author non-byline.; Coomaraswamy Michael author non-byline.; West Michaela A author non-byline.; Farhat Joseph author non-byline.; Brasel Karen J author non-byline.; Ballou Jessica H author non-byline.; Drumheller Byron C author non-byline.; Radowsky Jason author non-byline.; Dries David J author non-byline.; Ramey Elizabeth author non-byline.; Fakhry Samir M author non-byline.; Goulet Nicole author non-byline.; Livingston David H author non-byline.; Meizoso Jonathan P author non-byline.; Zakrison Tanya L author non-byline.; Wahl Wendy L author non-byline.; Brandt Mary-Margaret author non-byline.; Nasrallah Fady S author non-byline.; Schaffer Kathryn B author non-byline.; Sakran Joseph V author non-byline.; Kodadek Lisa M author non-byline.; Cardenas Tatiana C P author non-byline.; Rani Meenakshi author non-byline.; Khan Abid author non-byline.; Moskowitz Elisa author non-byline.; Costantini Todd W author non-byline.; Doucet Jay J author non-byline.; Schroeppel Thomas author non-byline.; Corey Katherine author non-byline.; Pederson Claire author non-byline.; Martin Kevin H author non-byline.; Bosarge Patrick L author non-byline.; Farley Paige author non-byline.; Nahmias Jeffry author non-byline.; Grigorian Areg author non-byline.; Crandall Marie author non-byline.; Mull Jennifer author non-byline.; Efron Philip A author non-byline.; Davis Ruth author non-byline.; Berdel Henrik author non-byline.; Culpepper Chris author non-byline.; West Sonlee D author non-byline.; Keiler-Green Ashley author non-byline.; Martin Niels D author non-byline.; Tung Lily author non-byline.; Sperry Jason L author non-byline.; Anto Vincent P author non-byline.; Nirula Ram author non-byline.; Buhavac Milos author non-byline.; Dultz Linda Ann author non-byline.; Podbielski Jeanette author non-byline.; Kao Lillian author non-byline.; Adams Reanna author non-byline.; Romero Javier author non-byline.; Diaz Graal author non-byline.; Bochicchio Grant V author non-byline.; Rasane Rohit K author non-byline.; Maung Adrian A author non-byline.; Hill Casey author non-byline.; Campbell Andre author non-byline.; Stey Anne author non-byline.;
• Is Part Of: Trauma surgery & acute care open. Volume 4:Issue 1(2019)
• Publication Date: 2019-02-18
• Subjects: surgical critical care -- prevalence study -- trauma intensive care unit -- ICU mortality -- critical care diagnoses; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2018-000288
• Languages: English
• ISSNs: 2397-5776

Abstract

Abstract : Background: Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients. Methods: This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018. Results: Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41–70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4–20). 30-day mortality was 11.2%. Conclusions: Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers. Level of evidence: IV, prospective observational study.