Survival outcomes after prolonged intensive care unit length of stay among trauma patients: The evidence for never giving up.
Prolonged intensive care unit length of stay (ICU-LOS) is associated with high mortality for medical and surgical patients. Existing literature suggests that this may not be true for trauma patients. The objective of this study was to determine mortality associated with varying ICU-LOS among trauma patients and to assess for independent predictors of mortality.



Adult ICU patients (16-64 years) in the National Trauma Data Bank (2007-2012) were categorized by ICU-LOS: 1, 2-9, 10-40, and >40 days (determined based on inflection points). Multivariable logistic regression was used to determine associations with mortality for each. Models accounted for clustering of patients within hospitals and potential confounding associated with: age, gender, race/ethnicity, insurance status, Injury Severity Score, blunt/penetrating injury, Glasgow Coma Scale, in-hospital complications, ventilator dependency, and emergency department disposition.



Among the 596,598 patients included, 6.5% (n = 38,812) died. Mortality varied with ICU-LOS: 9.9%, 4.9%, 6.6%, and 9.8%. Age >35 years was a significant predictor of mortality in each. Injury Severity Score and the Glasgow Coma Scale independently predicted mortality in patients with LOS ≤40 days as did penetrating injuries, cardiac arrest, and renal failure. Identification with non-Hispanic black race/ethnicity was also consistently significant. Once patients survived 9 days, mortality steadily decreased, remaining relatively stable until 40 days. Thereafter, trauma patients continued to demonstrate high survival with >87% remaining alive in the ICU >90 days.



The results reveal that in contrast to expectations of high mortality associated with prolonged ICU-LOS, critically injured adult trauma patients who do not die within the first few days demonstrate an enhanced ability to survive, with an overall survival of >92% and maintained at >85% among extreme ICU-LOS (>40 days). The data advocate the utility of aggressive critical-care support for trauma patients, irrespective of duration of ICU stay.
Department of Surgery, University of Arizona, Tucson, AZ; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham & Women's Hospital, Boston, MA.
Mehreen T
MT
Kisat
Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Asad
A
Latif
Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham & Women's Hospital, Boston, MA.
Cheryl K
CK
Zogg
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Elliott R
ER
Haut
Department of Surgery, Howard University College of Medicine, Washington, DC.
Syed Nabeel
SN
Zafar
Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD.
Zain G
ZG
Hashmi
Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO.
Tolulope A
TA
Oyetunji
Department of Surgery, Howard University College of Medicine, Washington, DC.
Edward E
EE
Cornwell
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Hasnain
H
Zafar
Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham & Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
Adil H
AH
Haider
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult