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. 2016 Jun 15;203(2):338-47.
doi: 10.1016/j.jss.2016.03.049. Epub 2016 Mar 30.

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

Elinore J Kaufman  1 , Douglas J Wiebe  2 , Niels D Martin  3 , Jose L Pascual  3 , Patrick M Reilly  3 , Daniel N Holena  3
Affiliations

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

Elinore J Kaufman et al. J Surg Res. .

Abstract

Background: Although trauma patients are frequently cared for in the intensive care unit (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 from 2011-2014 at 30 level I and II Pennsylvania trauma centers. 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 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score 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%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers 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.

Keywords: Blunt splenic injury; ICU utilization; Trauma outcomes.

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Conflict of interest statement

Conflicts of Interest: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this manuscript.

Figures

Figure 1
Figure 1
Conceptual Model of ICU Utilization in Trauma
Figure 2
Figure 2
Study Inclusion and Exclusion Criteria
Figure 3
Figure 3
Pennsylvania Trauma Centers Observed-to-Expected Ratios for Mortality after Blunt Splenic Injury
Figure 4
Figure 4
Pennsylvania Trauma Centers Observed-to-Expected Ratios for ICU Utilization after Blunt Splenic Injury
See this image and copyright information in PMC

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