Association of Unplanned ICU Admission and Clinical Outcomes in Trauma Patients With Severe Sepsis

Abstract

Introduction

This study aims to evaluate the association between unplanned ICU admission and clinical outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, this study assesses predictors of worsened outcomes in this population.

Methods

This retrospective cohort study analyzed the ACS-TQIP database (2017-2023) to analyze outcomes associated with unplanned ICU admission in adult and geriatric trauma patients (ISS ≥ 15) with severe sepsis. The primary outcome was in-hospital mortality, and secondary outcomes included discharge disposition, ICU-LOS, ventilator-free days, and complications.

Results

In both adult and geriatric patients, unplanned ICU admission was associated with significantly lower in-hospital mortality (aOR: 0.460, 95% CI: 0.346-0.610, P < 0.001, SE: 0.145) (aOR: 0.657, 95% CI: 0.438-0.987, P = 0.043, SE: 0.207) and more ventilator-free days (β = 5.067, 95% CI: 3.981-6.153, P < 0.001, SE: 0.554) (β = 2.402, 95% CI: 0.625-4.180, P = 0.008, SE: 0.905). Advanced age (over 64 years) (aOR: 1.487, 95% CI: 1.140-1.924, P = 0.003, SE: 0.134), ISS over 25 (aOR: 1.487, 95% CI: 1.251-1.768, P < 0.001, SE: 0.088), and having multiple comorbidities (aOR: 1.402, 95% CI: 1.152-1.706, P < 0.001, SE: 0.100) were found to be associated with worse outcomes.

Conclusions

Findings from this national analysis highlighted predictors associated with worsening outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, while unplanned ICU admission was associated with improved outcomes in both adult and geriatric trauma patients with severe sepsis compared to those admitted to hospital floors, its high resource utilization emphasizes the importance of developing targeted care strategies to prevent resource overutilization and clinical deterioration in this patient population.