Trauma ICU Prevalence Project: The diversity of surgical critical care

Christopher P. Michetti, Samir M. Fakhry, Karen Brasel, Niels D. Martin, Erik J. Teicher, Anna Newcomb

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients. Methods This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018. Results Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41-70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4-20). 30-day mortality was 11.2%. Conclusions Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers. Level of evidence IV, prospective observational study.

Original languageEnglish (US)
Article numbere000288
JournalTrauma Surgery and Acute Care Open
Volume4
Issue number1
DOIs
StatePublished - Feb 1 2019

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Critical Care
Intensive Care Units
Wounds and Injuries
Patient Acuity
Rib Fractures
Hemothorax
Multiple Organ Failure
Hemorrhagic Shock
Trauma Centers
Tracheostomy
Adult Respiratory Distress Syndrome
Pneumothorax
Septic Shock
Artificial Respiration
Multicenter Studies
Observational Studies
Length of Stay
Cross-Sectional Studies
Prospective Studies
Pathology

Keywords

  • critical care diagnoses
  • ICU mortality
  • prevalence study
  • surgical critical care
  • trauma intensive care unit

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Michetti, C. P., Fakhry, S. M., Brasel, K., Martin, N. D., Teicher, E. J., & Newcomb, A. (2019). Trauma ICU Prevalence Project: The diversity of surgical critical care. Trauma Surgery and Acute Care Open, 4(1), [e000288]. https://doi.org/10.1136/tsaco-2018-000288

Trauma ICU Prevalence Project : The diversity of surgical critical care. / Michetti, Christopher P.; Fakhry, Samir M.; Brasel, Karen; Martin, Niels D.; Teicher, Erik J.; Newcomb, Anna.

In: Trauma Surgery and Acute Care Open, Vol. 4, No. 1, e000288, 01.02.2019.

Research output: Contribution to journalArticle

Michetti, Christopher P. ; Fakhry, Samir M. ; Brasel, Karen ; Martin, Niels D. ; Teicher, Erik J. ; Newcomb, Anna. / Trauma ICU Prevalence Project : The diversity of surgical critical care. In: Trauma Surgery and Acute Care Open. 2019 ; Vol. 4, No. 1.
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abstract = "Background Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients. Methods This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers' trauma ICU (TICU) on November 2, 2017 and April 10, 2018. Results Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41-70). Patient types included trauma (n=665, 46.9{\%}), non-trauma surgical (n=536, 37.8{\%}), medical (n=204, 14.4{\%} overall), or unspecified (n=11). Surgical intensivists managed 73.1{\%} of patients. Of ICU-specific diagnoses, 57{\%} were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2{\%}; multiple organ failure, 5.58{\%}; adult respiratory distress syndrome, 4.38{\%}). Hemorrhagic shock was seen in 11.6{\%} of trauma patients and 6.55{\%} of all patients. The most common traumatic injuries were rib fractures (41.6{\%}), brain (38.8{\%}), hemothorax/pneumothorax (30.8{\%}), and facial fractures (23.7{\%}). Forty-four percent were on mechanical ventilation, and 17.6{\%} had a tracheostomy. One-third (33{\%}) had an infection, and over half (54.3{\%}) were on antibiotics. Operations were performed in 70.2{\%}, with 23.7{\%} having abdominal surgery. At 30 days, 5.4{\%} were still in the ICU. Median ICU length of stay was 9 days (IQR 4-20). 30-day mortality was 11.2{\%}. Conclusions Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers. Level of evidence IV, prospective observational study.",
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