title: Spectrum of critical illness in undocumented border crossers. The Arizona-Mexico border experience.
abstract: BACKGROUND
  Approximately 150-250 migrants die each year while attempting to cross the border from Mexico to the Southwest United States. Many border crossers survive the journey, but some develop life-threatening medical complications. Such complications have been subject to little formal analysis.
  
  
  OBJECTIVE
  We sought to determine the causes of critical illness in this population and to analyze the hospital course and outcomes of these patients.
  
  
  METHODS
  We retrospectively identified border crossers admitted to the intensive care units (ICUs) of two major teaching hospitals in southern Arizona. We recorded admitting diagnoses, severity of illness, length of stay, resource use, discharge diagnoses, and mortality.
  
  
  RESULTS
  Our investigation identified 55 admissions to adult ICUs between January 1, 2010 and December 31, 2012. The median age of patients was 27 years. The median hospital length of stay was 7 days, with a median ICU length of stay of 3 days. The median temperature on arrival to the emergency department was 36.8°C. The most common admission diagnoses included trauma (40), rhabdomyolysis (27), acute liver injury (25), dehydration (24), acute kidney injury (19), and encephalopathy (17). Thirteen patients presented with respiratory failure, six patients with severe sepsis, and two with septic shock. A total of 19 patients required ventilator support during their hospital stay, and 30 required at least one surgical intervention. One patient required renal replacement therapy. The median Acute Physiology and Chronic Health Evaluation II score was 6. All but one patient survived to discharge from the hospital.
  
  
  CONCLUSIONS
  Border crossers are a unique population of young individuals exposed to high temperatures and extreme conditions. Our review of border crosser admissions showed that most patients demonstrated signs of dehydration and leukocytosis, despite a normal median temperature. The median ICU stay was short, despite a high number of patients requiring ventilator support and surgical intervention. Only one death occurred in this cohort.
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Candy
authors.initials: C
authors.lastname: Wong
authors.forename: Wendy
authors.initials: W
authors.lastname: Hsu
authors.forename: Gordon E
authors.initials: GE
authors.lastname: Carr
mesh_terms: D000293:Adolescent; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014195:Travel; D055815:Young Adult
keywords: critical care; emigrants; immigrants