title: Variation in intensive care unit utilization and mortality after blunt splenic injury.
abstract: Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission.
  
  
  
  We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers.
  
  
  
  Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers.
  
  
  
  Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality.
authors.affiliation: Master of Science in Health Policy Program, Philadelphia, Pennsylvania. Electronic address: elinore@mail.med.upenn.edu.
authors.forename: Elinore J
authors.initials: EJ
authors.lastname: Kaufman
authors.affiliation: Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.affiliation: Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania.
authors.forename: Niels D
authors.initials: ND
authors.lastname: Martin
authors.affiliation: Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Pascual
authors.affiliation: Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.affiliation: Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, Pennsylvania.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000592:standards; D010414:Pennsylvania; D012042:Registries; D012189:Retrospective Studies; D020379:Risk Adjustment; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000628:therapy*
keywords: Blunt splenic injury; ICU utilization; Trauma outcomes