Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases

Abstract

IntroductionThere are many potential influencing factors that affect the duration of intensive care treatment for patients who have survived multiple trauma. Yet the respective factors’ relevance to ICU length of stay (LOS) has been rarely studied. Thus, the aim of the present study was to investigate to what extent specific factors influence ICU LOS in surviving trauma patients.MethodsWe retrospectively analyzed a dataset of 30,157 surviving trauma patients from the TraumaRegister DGU® who were older than six years of age and received subsequent intensive care treatment for more than one day, from 2002 to 2011. Univariate analysis and multiple linear regression analysis were used to examine 25 categorical pre- and post-trauma parameters.ResultsUnivariate analysis confirmed the impact of all analyzed factors. In subsequent multiple linear regression analyses, coefficients ranged from -1.3 to +8.2 days. The factors that influenced the prolongation of ICU LOS most were renal failure (+8.1 days), sepsis (+7.8 days) and respiratory failure (+4.9 days). Patients spent one additional day in the ICU for every 5 additional points on the Injury Severity Score (regression coefficient +0.2 per point). Furthermore, massive transfusion (+3.3 days), invasive ventilation (+3.1 days), and an initial Glasgow Coma Scale score ≤8 (+3.0 days) had a significant impact on ICU LOS. The coefficient of determination for the model was 44% (R2).ConclusionsTreatment regimens, as well as secondary effects and complications of trauma and intensive care treatment, prolong ICU LOS more than the mechanism of trauma or pre-trauma patient conditions. Successful prevention of complicated courses of illness, such as sepsis and renal and respiratory failure, could significantly abbreviate the ICU stay in trauma patients. Therefore, the staff’s attention should be focused on preventive strategies.

Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study

“…Patients who developed sepsis had 7.8 days longer ICU stay, and patients with respiratory failure had 4.9 days longer ICU stay. 18 They also determined that patients with an initial Glasgow Coma Scale ≤8 had significantly longer ICU stay. 18 The results illustrate potential economic implications as conservative management of high-grade renal trauma may not incur higher medical costs related to longer hospitalizations.…”

“…18 They also determined that patients with an initial Glasgow Coma Scale ≤8 had significantly longer ICU stay. 18 The results illustrate potential economic implications as conservative management of high-grade renal trauma may not incur higher medical costs related to longer hospitalizations. Conservative management allows high-grade renal trauma patients to avoid complications associated with surgical procedures that can also lead to an extended hospital LOS.…”

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

“…Variables representing patient/injury characteristics and hospital resource usage were grouped for statistical analysis. Patient/injury characteristic variables known to be associated with trauma outcomes included age, [33][34][35] Injury Severity Score (ISS), 16,36 and score on the Glasgow Coma Scale (GCS). 35,37 Number of physiological complications (eg, cardiovascular, gastrointestinal, hematologic, hepatic/pancreatic/ biliary/splenic, infectious, musculoskeletal/integumentary, neurological, pulmonary, renal/genitourinary, vascular), hypothesized to be related to resource usage because of increased complications for obese patients 7,9,[15][16][17][18]24 was also included as an injury factor.…”

“…2 Obesity is a national epidemic that affects all aspects of health care, including trauma care. 3 According to the Centers for Disease Control and Prevention, 4 35.1% of US adults 20 years old and older are obese (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, > 30), and 69% are overweight (BMI > 25). Obesity is a major health concern because of its established relationship with serious medical diseases and increased likelihood of comorbid conditions (eg, diabetes mellitus, hyperlipidemia, heart disease, pulmonary disease).…”

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

“…Short-term consequences of injury, hemorrhage, and subsequent transfusion of blood components, primarily mortality and major complications during hospitalization, have been described, especially among patients with trauma who received massive transfusions. [6][7][8] Long-term physiological and psychological consequences of traumatic injury have also been widely studied; the primary focus has ranged from rehabilitation (physiological) to posttraumatic stress disorder and depression (psychological). [9][10][11][12] A clear understanding of the association between transfusion of blood components in patients with major trauma and subsequent short-and long-term outcomes will contribute to the effective delivery of care and improved patient recovery.…”