Acute Crit Care.  2024 Nov;39(4):583-592. 10.4266/acc.2024.00584.

Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea

• Lee Y
• Kang BH

• KMID: 2563547
• DOI: http://doi.org/10.4266/acc.2024.00584

Abstract

Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.

Keyword

intensive care units; patient readmission; trauma centers; risk factors

Figure

• 

  Figure 1. Patient inclusion/exclusion flowchart. ICU: intensive care unit; ISS: injury Severity Score.

• 

  Figure 2. Reasons for unplanned intensive care unit readmission. CRRT: continuous renal replacement therapy.

Reference

1. Christmas AB, Freeman E, Chisolm A, Fischer PE, Sachdev G, Jacobs DG, et al. Trauma intensive care unit 'bouncebacks': identifying risk factors for unexpected return admission to the intensive care unit. Am Surg. 2014; 80:778–82.

2. Fakhry SM, Leon S, Derderian C, Al-Harakeh H, Ferguson PL. Intensive care unit bounce back in trauma patients: an analysis of unplanned returns to the intensive care unit. J Trauma Acute Care Surg. 2013; 74:1528–33.

3. Morgan M, Vernon T, Bradburn EH, Miller JA, Jammula S, Rogers FB. A comprehensive review of the outcome for patients readmitted to the ICU following trauma and strategies to decrease readmission rates. J Intensive Care Med. 2020; 35:936–42.

4. Rubano JA, Vosswinkel JA, McCormack JE, Huang EC, Shapiro MJ, Jawa RS. Unplanned intensive care unit admission following trauma. J Crit Care. 2016; 33:174–9.

5. Rosenberg AL, Hofer TP, Hayward RA, Strachan C, Watts CM. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med. 2001; 29:511–8.

6. Rosenberg AL, Watts C. Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest. 2000; 118:492–502.

7. Nishi GK, Suh RH, Wilson MT, Cunneen SA, Margulies DR, Shabot MM. Analysis of causes and prevention of early readmission to surgical intensive care. Am Surg. 2003; 69:913–7.

8. Chrusch CA, Olafson KP, McMillan PM, Roberts DE, Gray PR. High occupancy increases the risk of early death or readmission after transfer from intensive care. Crit Care Med. 2009; 37:2753–8.

9. Laytin AD, Sims CA. Risk factors for unplanned ICU readmission among trauma patients: age matters. Crit Care Explor. 2022; 4:e0778.

10. Johns TJ. Characteristics and risk factors of trauma patients readmitted to the ICU within the same hospitalization. J Trauma Nurs. 2014; 21:14–21.

11. Bradburn EH, Jammula S, Horst MA, Morgan M, Vernon TM, Gross BW, et al. An analysis of outcomes and predictors of intensive care unit bouncebacks in a mature trauma system. J Trauma Acute Care Surg. 2020; 88:486–90.

12. American College of Surgeons. National trauma data standard data dictionary 2022 [Internet]. American College of Surgeons; 2024 [cited 2024 Aug 4]. Available from: https://www.facs.org/quality-programs/trauma/quality/national-trauma-data-bank/national-trauma-data-standard/data-dictionary/.

13. Zimmerman JE. Intensive care unit readmission: the issue is safety not frequency. Crit Care Med. 2008; 36:984–5.

14. Wong EG, Parker AM, Leung DG, Brigham EP, Arbaje AI. Association of severity of illness and intensive care unit readmission: a systematic review. Heart Lung. 2016; 45:3–9.

15. Ho KM, Dobb GJ, Lee KY, Finn J, Knuiman M, Webb SA. The effect of comorbidities on risk of intensive care readmission during the same hospitalization: a linked data cohort study. J Crit Care. 2009; 24:101–7.

16. Utzolino S, Kaffarnik M, Keck T, Berlet M, Hopt UT. Unplanned discharges from a surgical intensive care unit: readmissions and mortality. J Crit Care. 2010; 25:375–81.

17. Forster GM, Bihari S, Tiruvoipati R, Bailey M, Pilcher D. The association between discharge delay from intensive care and patient outcomes. Am J Respir Crit Care Med. 2020; 202:1399–406.

18. Berardino M, Morrone O, Sciacca PF, Rosato R, Ciccone G, Massaro F. Discharge criteria from intensive care unit in brain injured patients. Acta Neurochir (Wien). 2004; 146:453–6.

19. Kafantaris S, Kadda O. Advantages and disadvantages of patients’ hospitalization in intensive care units. Health Res J. 2021; 7:155–9.

20. Debkowska MP, Butterworth JF, Moore JE, Kang S, Appelbaum EN, Zuelzer WA. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy. J Spine Surg. 2019; 5:142–54.

21. Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine (Phila Pa 1976). 2002; 27:949–53.

22. Boddapati V, Lee NJ, Mathew J, Held MB, Peterson JR, Vulapalli MM, et al. Respiratory compromise after anterior cervical spine surgery: incidence, subsequent complications, and independent predictors. Global Spine J. 2022; 12:1647–54.

23. Nandyala SV, Marquez-Lara A, Park DK, Hassanzadeh H, Sankaranarayanan S, Noureldin M, et al. Incidence, risk factors, and outcomes of postoperative airway management after cervical spine surgery. Spine (Phila Pa 1976). 2014; 39:E557–63.

24. Kim M, Choi I, Park JH, Jeon SR, Rhim SC, Roh SW. Airway management protocol after anterior cervical spine surgery: analysis of the results of risk factors associated with airway complication. Spine (Phila Pa 1976). 2017; 42:E1058–66.

25. Okereke I, Mmerem K, Balasubramanian D. The management of cervical spine injuries: a literature review. Orthop Res Rev. 2021; 13:151–62.

26. Colón LF, Barber L, Soffin E, Albert TJ, Katsuura Y. Airway complications after anterior cervical spine surgery: etiology and risk factors. Global Spine J. 2023; 13:2526–40.

27. Ponzoni CR, Corrêa TD, Filho RR, Serpa Neto A, Assunção MS, Pardini A, et al. Readmission to the intensive care unit: incidence, risk factors, resource use, and outcomes. a retrospective cohort study. Ann Am Thorac Soc. 2017; 14:1312–9.

28. Jo YS, Lee YJ, Park JS, Yoon HI, Lee JH, Lee CT, et al. Readmission to medical intensive care units: risk factors and prediction. Yonsei Med J. 2015; 56:543–9.

29. Japiassú AM, Cukier MS, Queiroz AG, Gondim CR, Penna GL, Almeida GF, et al. Early predictive factors for intensive care unit readmission. Rev Bras Ter Intensiva. 2009; 21:353–8.

30. Siqueira Santos MM, Sganzerla D, Pereira IJ, Rosa RG, Granja C, Teixeira C, et al. Long-term mortality and health-related quality of life after continuous versus intermittent renal replacement therapy in ICU survivors: a secondary analysis of the quality of life after ICU study. J Intensive Care Med. 2024; 39:636–45.

31. Oeyen S, De Corte W, Benoit D, Annemans L, Dhondt A, Vanholder R, et al. Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement therapy: a matched cohort study. Crit Care. 2015; 19:289.

32. Shingarev R, Wille K, Tolwani A. Management of complications in renal replacement therapy. Semin Dial. 2011; 24:164–8.

33. Makris N, Dulhunty JM, Paratz JD, Bandeshe H, Gowardman JR. Unplanned early readmission to the intensive care unit: a case-control study of patient, intensive care and ward-related factors. Anaesth Intensive Care. 2010; 38:723–31.

34. Lee HF, Lin SC, Lu CL, Chen CF, Yen M. Revised Acute Physiology and Chronic Health Evaluation score as a predictor of neurosurgery intensive care unit readmission: a case-controlled study. J Crit Care. 2010; 25:294–9.