Unexpected ICU Admission Is Associated with Pulmonary Complications but Not Increased Mortality; Rescue Is Essential for Optimal Patient Outcome.

ABSTRACT

ICU beds are in demand in large regional referral hospitals; therefore, nonintubated polytrauma patients are often admitted to general care (GC) wards. We hypothesized that trauma patients with Injury Severity Score (ISS) greater than 15 and unexpected ICU admission (U-ICU) after initial admission to GC had increased morbidity and mortality. We also hypothesized that those requiring U-ICU could be predicted based on admission parameters. This was a retrospective review of patients aged at least 18 years, admitted to GC with blunt trauma and ISS greater than 15 from April 2015 to March 2017. Demographics were collected along with injury patterns and complications. Statistics included chi-squared, Fisher's exact, Mann-Whitney, and t tests. Of 986 patients, 502 (50.9%) were directly admitted to GC. Prevalence of U-ICU was 9.8 per cent (49/502 patients). The only admission predictor of U-ICU was a history of myocardial infarction (8/49, 16.3%, vs 21/453, 4.6%, P = 0.001). Those with U-ICU had increased incidence of pneumonia, acute respiratory distress syndrome, and endotracheal intubation compared with GC, but there was no difference in overall mortality (3/49, 6.1% vs 18/453, 4.0%, P = 0.45). Half of all severely injured, nonintubated patients can be managed on the GC ward; however, 9.8 per cent of patients will require U-ICU admission for pulmonary complications. Admission history of myocardial infarction predicts those at risk. Severely injured patients with U-ICU admission have significant cardiopulmonary complications, but can be rescued with no increase in overall mortality.