Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 9, 2025; 14(2): 101957
Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101957
Characteristics and outcomes of trauma patients with unplanned intensive care unit admissions: Bounce backs and upgrades comparison
Alexander A Fokin, Joanna Wycech Knight, Phoebe K Gallagher, Justin Fengyuan Xie, Kyler C Brinton, Madison E Tharp, Ivan Puente
Alexander A Fokin, Joanna Wycech Knight, Phoebe K Gallagher, Justin Fengyuan Xie, Kyler C Brinton, Madison E Tharp, Ivan Puente, Department of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
Alexander A Fokin, Phoebe K Gallagher, Justin Fengyuan Xie, Kyler C Brinton, Madison E Tharp, Ivan Puente, Department of Surgery, Florida Atlantic University Charles E Schmidt College of Medicine, Boca Raton, FL 33431, United States
Joanna Wycech Knight, Ivan Puente, Department of Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
Ivan Puente, Department of Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL 33199, United States
Author contributions: Fokin AA, Wycech Knight J, and Puente I conceptualized and designed the research study; Fokin AA and Puente I overlooked the study; Wycech Knight J, Gallagher PK, Xie JF, Brinton KC, and Tharp ME performed the research; Fokin AA, Wycech Knight J, Gallagher PK, Xie JF, Brinton KC, and Tharp ME analyzed the data; Fokin AA, Wycech Knight J, Gallagher PK, Xie JF, Brinton KC, Tharp ME, and Puente I contributed to writing the original draft and the revision; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was approved by the MetroWest Institutional Review Board, Framingham, MA under the protocol No. 2023-060.
Informed consent statement: This retrospective study was granted a waiver of informed consent by the MetroWest Institutional Review Board.
Conflict-of-interest statement: The authors declare that they have no conflict of interest. The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Data sharing statement: Deidentified data and study materials are available upon reasonable request from the corresponding author at alexander.fokin@tenethealth.com.
STROBE statement: The authors have read the STROBE statement–checklist of items, and the manuscript was prepared and revised according to the STROBE statement–checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alexander A Fokin, MD, PhD, Instructor, Professor, Researcher, Department of Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, United States. alexander.fokin@tenethealth.com
Received: October 3, 2024
Revised: November 21, 2024
Accepted: December 9, 2024
Published online: June 9, 2025
Processing time: 146 Days and 18.2 Hours
Abstract
BACKGROUND

The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit (ICU) is an unanticipated event with possible life-threatening consequences. Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality. Two different types of unplanned ICU admissions include upgrades (patients admitted to the floor then moved to the ICU) and bounce backs (patients admitted to the ICU, discharged to the floor, and then readmitted to the ICU). Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.

AIM

To analyze the characteristics, management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.

METHODS

This institutional review board approved, retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period (2017-2023). This included 134 upgrades and 69 bounce backs. Analyzed variables included: (1) Age; (2) Sex; (3) Comorbidities; (4) Mechanism of injury (MOI); (5) Injury severity score (ISS); (6) Glasgow Coma Scale (GCS); (7) Type of injury; (8) Transfusions; (9) Consultations; (10) Timing and reason for unplanned admission; (11) Intubations; (12) Surgical interventions; (13) ICU and hospital lengths of stay; and (14) Mortality.

RESULTS

Unplanned ICU admissions comprised 4.2% of total ICU admissions. Main MOI was falls. Mean age was 70.7 years, ISS was 12.8 and GCS was 13.9. Main injuries were traumatic brain injury (37.4%) and thoracic injury (21.7%), and main reason for unplanned ICU admission was respiratory complication (39.4%). The 47.3% underwent a surgical procedure and 46.8% were intubated. Average timing for unplanned ICU admission was 2.9 days. Bounce backs occurred half as often as upgrades, however had higher rates of transfusions (63.8% vs 40.3%, P = 0.002), consultations (4.8 vs 3.0, P < 0.001), intubations (63.8% vs 38.1%%, P = 0.001), longer ICU lengths of stay (13.2 days vs 6.4 days, P < 0.001) and hospital lengths of stay (26.7 days vs 13.0 days, P < 0.001). Mortality was 25.6% among unplanned ICU admissions, 31.9% among geriatric unplanned ICU admissions and 11.9% among all trauma ICU patients.

CONCLUSION

Unplanned ICU admissions constituted 4.2% of total ICU admissions. Respiratory complications were the main cause of unplanned ICU admissions. Bounce backs occurred half as often as upgrades, but were associated with worse outcomes.

Keywords: Unplanned intensive care unit admissions; Trauma intensive care unit; Bounce backs; Upgrades; Level 1 trauma center; Geriatric trauma patients; Quality of care indicator

Core Tip: Unplanned intensive care unit (ICU) admissions constituted 4.2% of all trauma ICU admissions. Although upgrades happened more often, bounce backs were associated with worse outcomes, particularly in geriatric patients. Traumatic brain injuries and thoracic injuries together accounted for more than half of the injuries in trauma patients who required an unplanned ICU admission and this tendency was more pronounced in bounce backs and in geriatric patients. Three quarters of unplanned ICU admissions occurred within the first 72 hours of hospitalization. The main reasons for unplanned ICU admissions were respiratory complications. Patients with unplanned ICU admissions had twice the mortality of general trauma ICU patients.