title: Hospital length of stay after admission for traumatic injury in Canada: a multicenter cohort study.
abstract: OBJECTIVE
  To describe acute care length of stay (LOS) over all consecutive hospitalizations for the injury and according to level of care [intensive care unit (ICU), intermediate care, general ward], compare observed and expected LOS, and identify predictors of LOS.
  
  
  BACKGROUND
  Prolonged LOS has important consequences in terms of costs and outcome, yet detailed information on LOS after trauma is lacking.
  
  
  METHODS
  This multicenter retrospective cohort study was based on adults discharged alive from a Canadian trauma system (1999-2010; n = 126,513). Registry data were used to calculate index LOS (LOS in trauma center with highest designation level) and were linked to hospital discharge data to calculate total LOS (all consecutive hospitalizations for the injury). Expected LOS was obtained by matching general provincial discharge statistics to study data by year, age, and sex. Potential predictors of LOS were evaluated using linear regression.
  
  
  RESULTS
  Mean index and total LOS were 8.6 and 9.4 days, respectively. ICU, intermediate care unit, and general ward care constituted 8.9%, 2.5%, and 88.6% of total hospital days. Observed mean index and ICU LOS in our trauma patients were 2.9 and 1.3 days longer than expected LOS (P < 0.0001). The strongest determinants of index LOS were discharge destination, age, transfer status, and injury severity.
  
  
  CONCLUSIONS
  Results suggest that acute care LOS after injury is underestimated when only information on the index hospitalization is used and that ICU or intermediate care constitute an important part of LOS. This information should be used to inform the development of an informative and actionable quality indicator.
authors.affiliation: *Department of Social and Preventative Medicine, Université Laval, Québec, Canada; †Unité de traumatologie-urgence-soins intensifs, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, Canada; ‡Department of Critical Care Medicine, Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; §Department of Anesthesiology, Division of Critical Care Medicine, Québec, Canada; ¶Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto; and ‖Institut national d'excellence en santé et en services sociaux, Montréal, Québec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Henry Thomas
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.forename: Gilles
authors.initials: G
authors.lastname: Bourgeois
authors.forename: Jean
authors.initials: J
authors.lastname: Lapointe
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gagné
authors.forename: André
authors.initials: A
authors.lastname: Lavoie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult