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Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study

Adrian W Ong1*, Laurel A Omert2, Diane Vido3, Brian M Goodman1, Jack Protetch1, Aurelio Rodriguez1 and Elan Jeremitsky1

Author Affiliations

1 Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh PA 15212, USA

2 Northfield Laboratories Inc., 1560, Sherman Avenue, Evanston, IL 60201, USA

3 Department of Cardiology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh PA 15212, USA

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Critical Care 2009, 13:R154 doi:10.1186/cc8054

Published: 24 September 2009

Abstract

Introduction

Prolonged intensive care unit lengths of stay (ICU LOS) for critical illness can have acceptable mortality rates and quality of life despite significant costs. Only a few studies have specifically addressed prolonged ICU LOS after trauma. Our goals were to examine characteristics and outcomes of trauma patients with LOS ≥ 30 days, predictors of prolonged stay and mortality.

Methods

All trauma ICU admissions over a seven-year period in a level 1 trauma center were analyzed. Admission characteristics, pre-existing conditions and acquired complications in the ICU were recorded. Logistic regression was used to identify independent predictors of prolonged LOS and predictors of mortality among those with prolonged LOS after univariate analyses.

Results

Of 4920 ICU admissions, 205 (4%) had ICU LOS >30 days. These patients were older and more severely injured. Age and injury severity score (ISS) were associated with prolonged LOS. After logistic regression analysis, sepsis, acute respiratory distress syndrome, and several infectious complications were important independent predictors of prolonged LOS. Within the group with ICU LOS >30 days, predictors of mortality were age, pre-existing renal disease as well as the development of renal failure requiring dialysis. Overall mortality was 12%.

Conclusions

The majority of patients with ICU LOS ≥ 30 days will survive their hospitalization. Infectious and pulmonary complications were predictors of prolonged stay. Further efforts targeting prevention of these complications are warranted.