Does unit designation matter? A dedicated trauma intensive care unit is associated with lower postinjury complication rates and death after major complication

Marko Bukur; Fahim Habib; Joe Catino; Michael Parra; Robyn Farrington; Maggie Crawford; Ivan Puente

doi:10.1097/TA.0000000000000613

Does unit designation matter? A dedicated trauma intensive care unit is associated with lower postinjury complication rates and death after major complication

J Trauma Acute Care Surg. 2015 May;78(5):920-7; discussion 927-9. doi: 10.1097/TA.0000000000000613.

Authors

Marko Bukur¹, Fahim Habib, Joe Catino, Michael Parra, Robyn Farrington, Maggie Crawford, Ivan Puente

Affiliation

¹ From the Division of Trauma and Surgical Critical Care (M.B., J.C., M.P., M.C., I.P.), Department of Surgery, Delray Medical Center, Delray Beach; Division of Trauma and Surgical Critical Care (M.B., F.H., J.C., M.P., R.F., I.P.), Department of Surgery, Broward General Medical Center, Fort Lauderdale; Herbert Wertheim College of Medicine (M.B., F.H., I.P.), Florida International University, University Park; and Charles E Schmidt College of Medicine (M.B., I.P.), Florida Atlantic University, Boca Raton, Florida.

PMID: 25909410
DOI: 10.1097/TA.0000000000000613

Abstract

Background: Recent data suggest that specialty intensive care units (ICUs) have outcomes better than those of mixed ICUs. The cause for this apparent discrepancy has not been well established. We hypothesized that trauma patients admitted to a dedicated trauma ICU (TICU) would have a lower complication rate as well as death after complication (failure to rescue [FTR]).

Methods: This was a retrospective review of the ICUs of two Level I trauma centers covered by one group of surgical intensivists. One center has a dedicated TICU, while the other has a mixed ICU. Demographic and clinical characteristics were stratified into TICU and ICU groups. The primary outcomes were postinjury complications and FTR. Multivariate regression was used to derive factors associated with complications and FTR.

Results: During the 5-year study period, 3,833 patients were analyzed. TICU patients were older (57.8 vs. 47.0 years, p < 0.0001), had higher Charlson score (2 vs. 1, p = 0.001), had more severe head injuries (Head Abbreviated Injury Scale [AIS] score ≥ 3, 50.0% vs. 37.5%, p < 0.0001), and had greater injury burden (Injury Severity Score [ISS] > 16, 49.6% vs. 38.6%, p < 0.0001) than those admitted to the mixed ICU. Need for immediate operative intervention was similar (18.0% vs. 17.6%, p = 0.788). Overall complications were significantly higher in trauma patients admitted to the mixed ICU (27.5% vs. 17.0%, p < 0.0001), as well as FTR (3.7% vs. 1.8%, p < 0.0001). Trauma patients admitted to a dedicated TICU had significantly lower chance of developing a postinjury complication (adjusted odds ratio [AOR], 0.5; p < 0.0001), FTR (AOR, 0.3; p < 0.0001), and overall mortality (AOR, 0.4; p < 0.0001).

Conclusion: Admission of critically ill trauma patients to a TICU staffed by a surgical intensivist is associated with a lower complication rate and FTR. Factors such as trauma nursing experience, education, and unit management structure should be further explored to elucidate the observed improved outcomes.

Level of evidence: Prognostic study, level III.

Publication types

Multicenter Study

MeSH terms

Abbreviated Injury Scale*
Critical Illness / mortality*
Female
Hospital Mortality
Humans
Intensive Care Units / organization & administration*
Male
Middle Aged
Organizational Innovation*
Retrospective Studies
Risk Assessment*
Survival Analysis
Trauma Centers / organization & administration*
United States / epidemiology
Wounds and Injuries / diagnosis
Wounds and Injuries / mortality*