TY - JOUR
T1 - Prolonged ICU stay and its association with 1-year trauma mortality
T2 - An analysis of 19,000 American patients
AU - Chaudhary, Muhammad Ali
AU - Schoenfeld, Andrew J.
AU - Koehlmoos, Tracey P.
AU - Cooper, Zara
AU - Haider, Adil H.
N1 - Funding Information:
This project was funded in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine (Grant# HU0001-11-1-0023 ) of the Department of Defense (DoD). The following authors receive partial salary support from this grant: MAC, AJS, TPK, AHH. The Henry Jackson Foundation was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The DoD was not involved in the design, analyses or interpretation of results. The findings and views expressed here are those of the authors and should not be viewed as representative of the DoD or the United States Government. There are no other conflicts of interest to report.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/7
Y1 - 2019/7
N2 - Introduction: Prior research on patients with traumatic injury suggests high in-hospital survivability. However, little is known about their long-term outcomes, especially in the context of a prolonged ICU length-of-stay (LOS). We sought to determine the association between prolonged ICU-LOS and 1-year survival in trauma patients. Methods: TRICARE claims data (2011–2015) were queried for trauma patients with an Injury Severity Score > 9. Risk-adjusted Cox models were used to determine the influence of prolonged ICU LOS on 1-year mortality. Results: Of 19,155 patients included, 40% were admitted to the ICU. The overall 1-year mortality was 3.9% and 4.7% in patients with ICU LOS >9 days. In the multivariable model older age (55–64 vs. 18–24 years) (HR: 47.8, CI:20.8–109.9), prior comorbidities (>1 vs. 0) (HR: 2.6, CI: 2.1–3.2), discharge disposition (transfer vs discharge) (HR: 2.3 CI: 1.7–3.1) and ICU-LOS (>7 vs. 1 days) (HR:2.6, CI:1.7–4.0) were associated with 1-year mortality. Conclusion: Prolonged ICU-LOS is a risk factor for 1-year mortality in trauma patients. But an overall high survival (>96%) reinforces the justification for such use of the ICU in trauma patients when clinically necessary.
AB - Introduction: Prior research on patients with traumatic injury suggests high in-hospital survivability. However, little is known about their long-term outcomes, especially in the context of a prolonged ICU length-of-stay (LOS). We sought to determine the association between prolonged ICU-LOS and 1-year survival in trauma patients. Methods: TRICARE claims data (2011–2015) were queried for trauma patients with an Injury Severity Score > 9. Risk-adjusted Cox models were used to determine the influence of prolonged ICU LOS on 1-year mortality. Results: Of 19,155 patients included, 40% were admitted to the ICU. The overall 1-year mortality was 3.9% and 4.7% in patients with ICU LOS >9 days. In the multivariable model older age (55–64 vs. 18–24 years) (HR: 47.8, CI:20.8–109.9), prior comorbidities (>1 vs. 0) (HR: 2.6, CI: 2.1–3.2), discharge disposition (transfer vs discharge) (HR: 2.3 CI: 1.7–3.1) and ICU-LOS (>7 vs. 1 days) (HR:2.6, CI:1.7–4.0) were associated with 1-year mortality. Conclusion: Prolonged ICU-LOS is a risk factor for 1-year mortality in trauma patients. But an overall high survival (>96%) reinforces the justification for such use of the ICU in trauma patients when clinically necessary.
KW - 1-Year mortality
KW - Critical care
KW - Prolonged ICU stay
KW - TRICARE
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85060859883&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2019.01.025
DO - 10.1016/j.amjsurg.2019.01.025
M3 - Article
C2 - 30722934
AN - SCOPUS:85060859883
SN - 0002-9610
VL - 218
SP - 21
EP - 26
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 1
ER -