Trauma Surgery & Acute Care Open (Oct 2019)
Trauma ICU Prevalence Project: the diversity of surgical critical care
- ,
- Anne Stey,
- Ram Nirula,
- Katherine Corey,
- Marie Crandall,
- Rachel C Dirks,
- Thomas Schroeppel,
- Jeffry Nahmias,
- Areg Grigorian,
- Adrian A Maung,
- Jeanette Podbielski,
- Matthew M Carrick,
- Lisa M Kodadek,
- Chang Liu,
- Christopher P Michetti,
- Samir M Fakhry,
- Karen Brasel,
- Niels D Martin,
- Erik J Teicher,
- Anna Newcomb,
- Amy Stewart,
- Grace Chang,
- Michael Foreman,
- Evan Elizabeth Rainey,
- Forrest O (Dell) Moore,
- Jessica Huang,
- Krista Kaups,
- Rachel L Sensenig,
- Janika L San Roman,
- Clay Cothren Burlew,
- Eric M Campion,
- Len Weireter,
- Katherine Kelley,
- Dennis Kim,
- Erin Howell,
- Charles Hu,
- Karen Lewandowski,
- Elizabeth D Dauer,
- Kaushik Mukherjee,
- Liz G Penaloza,
- Daniel C Cullinane,
- Vaidehi Agrawal,
- Manuel Lorenzo,
- Dana Ferrari-Light,
- Michael Coomaraswamy,
- Michaela A West,
- Joseph Farhat,
- Karen J Brasel,
- Jessica H Ballou,
- Byron C Drumheller,
- Jason Radowsky,
- David J Dries,
- Elizabeth Ramey,
- Nicole Goulet,
- David H Livingston,
- Jonathan P Meizoso,
- Tanya L Zakrison,
- Wendy L Wahl,
- Mary-Margaret Brandt,
- Fady S Nasrallah,
- Kathryn B Schaffer,
- Joseph V Sakran,
- Tatiana C P Cardenas,
- Meenakshi Rani,
- Abid Khan,
- Elisa Moskowitz,
- Todd W Costantini,
- Jay J Doucet,
- Claire Pederson,
- Kevin H Martin,
- Patrick L Bosarge,
- Paige Farley,
- Jennifer Mull,
- Philip A Efron,
- Ruth Davis,
- Henrik Berdel,
- Chris Culpepper,
- Sonlee D West,
- Ashley Keiler-Green,
- Lily Tung,
- Jason L Sperry,
- Vincent P Anto,
- Milos Buhavac,
- Linda Ann Dultz,
- Lillian Kao,
- Reanna Adams,
- Javier Romero,
- Graal Diaz,
- Grant V Bochicchio,
- Rohit K Rasane,
- Casey Hill,
- Andre Campbell
Affiliations
- Anne Stey
- Ram Nirula
- University of Utah School of Medicine, Salt Lake City, Utah, USA
- Katherine Corey
- Marie Crandall
- Surgery, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida, USA
- Rachel C Dirks
- Department of Surgery, University of California San Francisco Fresno, Fresno, California, USA
- Thomas Schroeppel
- Jeffry Nahmias
- Texas Health Presbyterian Hospital, Dallas, Texas, USA
- Areg Grigorian
- University of California Irvine College of Medicine, Irvine, California, USA
- Adrian A Maung
- Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
- Jeanette Podbielski
- Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Matthew M Carrick
- 2 Department of Surgery, Medical City Healthcare, Plano, Texas, USA
- Lisa M Kodadek
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
- Chang Liu
- Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Christopher P Michetti
- unaffiliated, unaffiliated, Annandale, Virginia, USA
- Samir M Fakhry
- 1 Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare Inc, Nashville, Tennessee, USA
- Karen Brasel
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Niels D Martin
- Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Erik J Teicher
- 1 Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Anna Newcomb
- Inova Fairfax Medical Center, Falls Church, Virginia, USA
- Amy Stewart
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
- Grace Chang
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
- Michael Foreman
- Evan Elizabeth Rainey
- Forrest O (Dell) Moore
- Jessica Huang
- Krista Kaups
- 13 Department of Surgery, University of California San Francisco, Fresno, California, USA
- Rachel L Sensenig
- Janika L San Roman
- Clay Cothren Burlew
- Department of Surgery, Denver Health, Denver, Colorado, USA
- Eric M Campion
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
- Len Weireter
- Katherine Kelley
- Dennis Kim
- Erin Howell
- Charles Hu
- Karen Lewandowski
- Elizabeth D Dauer
- Kaushik Mukherjee
- 1 Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, California, USA
- Liz G Penaloza
- Daniel C Cullinane
- Maine Medical Center, Portland, Maine, USA
- Vaidehi Agrawal
- Manuel Lorenzo
- Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, Texas, USA
- Dana Ferrari-Light
- Michael Coomaraswamy
- Michaela A West
- Department Trauma and Acute Care Surgery, North Memorial Health, Minneapolis, Minnesota, USA
- Joseph Farhat
- Karen J Brasel
- Jessica H Ballou
- Byron C Drumheller
- Jason Radowsky
- David J Dries
- Elizabeth Ramey
- Nicole Goulet
- Surgery, Weill Cornell Medicine, New York, New York, USA
- David H Livingston
- Surgery, Rutgers, Newark, New Jersey, USA
- Jonathan P Meizoso
- Division of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Tanya L Zakrison
- Surgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
- Wendy L Wahl
- Mary-Margaret Brandt
- Fady S Nasrallah
- Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
- Kathryn B Schaffer
- Trauma Service, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
- Joseph V Sakran
- Center for Global Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Tatiana C P Cardenas
- Meenakshi Rani
- Abid Khan
- Elisa Moskowitz
- Todd W Costantini
- Surgery, University of California San Diego, San Diego, California, USA
- Jay J Doucet
- 3 Department of Surgery, University of California San Diego, La Jolla, California, USA
- Claire Pederson
- Medical Center of the Rockies, Loveland, Colorado, USA
- Kevin H Martin
- Patrick L Bosarge
- Paige Farley
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jennifer Mull
- Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
- Philip A Efron
- Ruth Davis
- Henrik Berdel
- Chris Culpepper
- Sonlee D West
- Ashley Keiler-Green
- Lily Tung
- Jason L Sperry
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vincent P Anto
- Milos Buhavac
- Linda Ann Dultz
- Lillian Kao
- Reanna Adams
- Javier Romero
- Graal Diaz
- Grant V Bochicchio
- Rohit K Rasane
- Casey Hill
- Andre Campbell
- DOI
- https://doi.org/10.1136/tsaco-2018-000288
- Journal volume & issue
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Vol. 4,
no. 1
Abstract
Background Surgical critical care is crucial to the care of trauma and surgical patients. This study was designed to provide a contemporary assessment of patient types, injuries, and conditions in intensive care units (ICU) caring for trauma patients.Methods This was a multicenter prevalence study of the American Association for the Surgery of Trauma; data were collected on all patients present in participating centers’ trauma ICU (TICU) on November 2, 2017 and April 10, 2018.Results Forty-nine centers submitted data on 1416 patients. Median age was 58 years (IQR 41–70). Patient types included trauma (n=665, 46.9%), non-trauma surgical (n=536, 37.8%), medical (n=204, 14.4% overall), or unspecified (n=11). Surgical intensivists managed 73.1% of patients. Of ICU-specific diagnoses, 57% were pulmonary related. Multiple high-intensity diagnoses were represented (septic shock, 10.2%; multiple organ failure, 5.58%; adult respiratory distress syndrome, 4.38%). Hemorrhagic shock was seen in 11.6% of trauma patients and 6.55% of all patients. The most common traumatic injuries were rib fractures (41.6%), brain (38.8%), hemothorax/pneumothorax (30.8%), and facial fractures (23.7%). Forty-four percent were on mechanical ventilation, and 17.6% had a tracheostomy. One-third (33%) had an infection, and over half (54.3%) were on antibiotics. Operations were performed in 70.2%, with 23.7% having abdominal surgery. At 30 days, 5.4% were still in the ICU. Median ICU length of stay was 9 days (IQR 4–20). 30-day mortality was 11.2%.Conclusions Patient acuity in TICUs in the USA is very high, as is the breadth of pathology and the interventions provided. Non-trauma patients constitute a significant proportion of TICU care. Further assessment of the global predictors of outcome is needed to inform the education, research, clinical practice, and staffing of surgical critical care providers.Level of evidence IV, prospective observational study.
