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. 2025 Jun 24;7(7):e1278.
doi: 10.1097/CCE.0000000000001278. eCollection 2025 Jul 1.

Surgical ICU Admission Criteria: A Scoping Review

Kenneth L Abbott  1 , Philip Hong  1 , Matthew M Ruppert  1 , Purvi P Patel  2 , Philip A Efron  1 , Natasha Keric  3 , Lewis J Kaplan  4 , Niels D Martin  4 , Tyler J Loftus  1
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Surgical ICU Admission Criteria: A Scoping Review

Kenneth L Abbott et al. Crit Care Explor. .

Abstract

Objectives: The aims of this scoping review were to: 1) explore factors driving surgical ICU (SICU) admission decisions, 2) provide an environmental scan of SICU admission practices, and 3) identify underexamined domains relevant for SICU triage, admission, and discharge inquiries.

Data sources: Embase, PubMed, and Medline were queried from inception to April 18, 2024, for English-language peer-reviewed studies related to adult SICU admission criteria and decision-making; neonatal ICU, PICU, veterinary ICU, and military ICU data and gray literature were excluded. Studies were not limited by design.

Study selection: Following duplicate removal, 363 of the initial 625 abstracts remained. After content screening, 54 abstracts remained topic aligned. Full-text review identified 44 articles appropriate for analysis.

Data extraction: Abstracted data addressed SICU structure, function, findings, and potential future directions.

Data synthesis: Most included studies (n = 23, 52%) focused on identifying risk factors for SICU admission or risk factors for the need for SICU admission, including demographics, comorbidities, and procedural specifics. Admission protocol evaluation studies were less common (n = 5, 11%), but offered promise in reducing unnecessary admissions using preoperative or postoperative interventions. Future inquiry domains included admission and discharge protocol development (n = 17, 39%), risk factors for ICU admission or the need for ICU admission (n = 16, 36%), multicenter studies (n = 16, 36%), additional or specific patient populations (n = 15, 34%), prospective studies (n = 14, 32%), costs (n = 6, 14%), and implementation of embedded clinical decision-support aids to inform SICU triage decision-making (n = 2, 5%). No included studies presented results regarding SICU discharge decision-making or ICU stress adaptations relevant during surge episodes.

Conclusions: Research on SICU triage decision-making primarily focuses at admission risk factor discovery, with less emphasis on protocol evaluation and implementation practices. Future research should focus on refining existing SICU triage approaches that include discharge and surge-based decision-making coupled with deployable clinical decision-support aids.

Keywords: decision support; intensive care; postoperative; surgery; triage.

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Conflict of interest statement

Dr. Abbott was supported by the National Institute of General Medical Sciences of the National Institutes of Health under award number T32 GM008721. Dr. Kaplan is the coprincipal investigator of a Veterans Affairs Cooperative Studies Program investigation under award number CSP 2040, funded by the Biomedical Advanced Research and Development Agency (solely provides project funding without salary support); he is a past president of the Society of Critical Care Medicine (2020–2021); he serves as an associate editor for Critical Care Explorations; and he sits on the editorial boards of Critical Care Medicine, Injury, Orthoplastic Surgery, and Surgical Infections. Dr. Loftus was supported by the National Institute of General Medical Sciences of the National Institutes of Health under award numbers K23 GM140268 and R01 GM149657. Drs. Loftus and Efron sit on the editorial board of Critical Care Explorations. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Primary study findings.
Figure 2.
Figure 2.
Study recommendations for future research.
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