Trauma observation unit-based pathway for treatment of injured patients: A retrospective study.

Abstract

Background: Trauma remains a leading cause of hospital admissions and mortality worldwide. In the Emergency Department, Trauma Observation Units (TOUs) have emerged as an effective strategy to optimize care for patients who do not require inpatient admission.

Objectives: To evaluate the outcome and safety of a TOU protocol on inpatient admission rates, length of stay, missed injuries, adverse outcomes, and 30-day emergency department (ED) readmissions among adult trauma patients.

Methodology: We conducted a retrospective observational study of all adult patients admitted under the TOU protocol at Hamad Trauma Center, between 2023 and 2024. Data included demographics, trauma activation level, injury severity score (ISS), diagnostic test, missed injuries, length of stay, adverse outcomes, inpatient admission rates, and ED re-admission within 30 days. Descriptive statistics were used to summarize patient characteristics and outcomes, with data reported as proportions, means ± SD, or medians (range), as appropriate.

Results: A total of 187 trauma patients were admitted to the TOU. The mean age was 37.6 ±14.9 years, with a predominance of males (154; 82.4%). The mean ISS was 5.5 ± 4.0. Frequent diagnoses included lacerations/soft tissue injuries (58; 31.0%), rib fractures (35; 18.7%), mild head injuries (29; 15.5%), and spinal transverse process fractures (19; 10.2%). The median duration of TOU stay was 10 hours (range 2-54). Repeated investigations were carried out in 36.4% of the total. Only one missed injury (1; 0.5%) occurred, without clinical consequence. Inpatient admission was required for 31 patients (16.6%), and 2 patients (1.1%) were readmitted within 30 days.

Conclusion: TOU was safe and effective in selected trauma patients, with no adverse outcomes and minimal missed injuries. This model offers a patient-centered, resource-efficient alternative to routine admission. Future multicenter studies should validate outcomes, cost-effectiveness, and patient-reported measures.