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BACKGROUND:ABC-123, a novel Epic electronic medical record real-time score, assigns 0 to 3 points per bundle element to assess ABCDEF bundle compliance. We sought to determine if maximum daily ABC-123 score (ABC-MAX), individual bundle elements, and mobility were associated with mortality and delirium-free/coma-free intensive care unit (DF/CF-ICU) days in critically injured patients. METHODS:We reviewed 6 months of single-center data (demographics, Injury Severity Score [ISS], Abbreviated Injury Scale of the head [AIS-Head] score, ventilator and restraint use, Richmond Agitation Sedation Score, Confusion Assessment Method for the ICU, ABC-MAX, ABC-123 subscores, and mobility level). Hospital mortality and likelihood of DF/CF-ICU days were endpoints for logistic regression with ISS, AIS-Head, surgery, penetrating trauma, sex, age, restraint and ventilator use, ABC-MAX or individual ABC-123 subscores, and mobility level or a binary variable representing any improvement in mobility during admission. RESULTS:We reviewed 172 patients (69.8% male; 16.3% penetrating; median age, 50.0 years [IQR, 32.0-64.8 years]; ISS, 17.0 [11.0-26.0]; AIS-Head, 2.0 [0.0-3.0]). Of all patients, 66.9% had delirium, 48.8% were restrained, 51.7% were ventilated, and 11.0% died. Age, ISS, AIS-Head, and penetrating mechanism were associated with increased mortality. Restraints were associated with more than 70% reduction in odds of DF/CF-ICU days. Maximum daily ABC-123 score and mobility level were associated with decreased odds of death and increased odds of DF/CF-ICU days. Any improvement in mobility during hospitalization was associated with an 83% reduction in mortality odds. A and C subscores were associated with increased mortality, and A was also associated with decreased DF/CF-ICU days. B and D subscores were associated with increased DF/CF-ICU days. D and E subscores were associated with decreased mortality. CONCLUSION:Maximum daily ABC-123 score is associated with reduced mortality and delirium in critically injured patients, while mobility is associated with dramatic reduction in mortality. B and D subscores have the strongest positive effects on both mortality and delirium.

METHODS: Our prospective trauma registry (2010-2018) was queried for patients with thoracic injuries. Patients were separated into geriatric (age!55) and non-geriatric (age!55) cohorts. Patients were compared based on the presence of posttraumatic empyema, confirmed by radiographic evidence and clinical evaluation. Data were analyzed using students t-test and X2 test. Multivariate regression was used for identifying risk factors. RESULTS: 2179 patients with chest trauma were included. 629 (28.9%) patients were in the geriatric cohort. No difference was found in the incidence of empyema between the geriatric and non-geriatric group (4.6% vs 4.8%, p¼0.96). Geriatric patients with empyema had significantly higher rates of trauma chest tube placement (62.1% vs 34.8%, p<0.01). After adjusting for age, gender, Charlson Comorbidity Index, AIS chest, and ventilator days, tube thoracotomy was an independent risk factor of posttraumatic empyema in geriatric patients (OR 3.15, p¼0.04). No difference was seen in the rate of chest tube placement in patients with or without empyema (48.6% vs 45.5%, p¼0.68) in the younger group. Patients with empyema in both age groups had significantly longer hospital LOS, ICU LOS, and ventilator days. CONCLUSION: Elderly patients with tube thoracostomy for chest injury was associated with increased risk of posttraumatic empyema and worse outcomes. Future studies are warranted to evaluate the benefit of prophylactic antibiotics in this high-risk population.