Variation in intensive care unit utilization and mortality after blunt splenic injury

Abstract

Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality.

Mortality in Patients with Splenic Injuries: The Role of Multi‐Organ Failure

“…Patients with high‐grade splenic injuries [4] and those with significant comorbidities [2] fared worse. In addition, whereas Kaufman et al [5] did not find a relationship between ICU admission and mortality from splenic injuries, a significantly higher proportion of their patients (64%) was admitted to ICU compared with ours (35%), which could explain the discrepancy between the two studies.…”

Comparison of Surgical and Non-Surgical Approaches to Splenic Trauma

“…In this regard, the proper selection of cases for each type of treatment (surgical or non-surgical) is essential. In another retrospective study carried out by Kaufman et al on 2587 patients, it was indicated that there is no relationship between the survival rate and use of ICU equipment (Kaufman et al, 2016). According to the results of a retrospective study conducted by Alamri et al on 238 patients, the mortality rate was higher among the patients older than 46 years, compared to that of the younger ones.…”