Characteristics and outcomes of trauma patients with unplanned intensive care unit admissions: Bounce backs and upgrades comparison

doi:10.5492/wjccm.v14.i2.101957

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Jun 9, 2025 (publication date) through Mar 2, 2025

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Crit Care Med. Jun 9, 2025; 14(2): 101957
Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101957

Table 1 General characteristics of patients with unplanned intensive care unit admissions, n (%)

Variable	ICU (n = 203)
Age (years), mean (SD)	70.7 (19.9)
Geriatric	141 (69.5)
Sex (male/female)	138 (68.0)/65 (32.0)
Comorbidities	186 (91.6)
Mechanism of injury	-
Fall	139 (68.5)
Motor vehicle	59 (29.1)
Other (assault, accident, and burn)	5 (2.5)
Glasgow Coma Scale, mean (SD) (range)	13.9 (2.7) (3-15)
ISS, mean (SD) (range)	12.8 (7.8) (1-38)
ISS ≥ 16	72 (35.5)
Upgrade/bounce back	134 (66.0)/69 (34.0)
Main injury	-
Head-traumatic brain injury	76 (37.4)
Thorax	44 (21.7)
Spine	26 (12.8)
Hip/pelvis	22 (10.8)
Abdominal	11 (5.4)
Extremities	7 (3.4)
Facial	8 (3.9)
Cardiac	6 (3.0)
Pulmonary contusion	14 (6.9)
Pneumothorax	18 (8.9)
Hemothorax	26 (12.8)
Pneumohemothorax	11 (5.4)
Any blood transfusion	98 (48.3)
Any surgical procedure	96 (47.3)
Number of consultations, mean (SD)	3.6 (1.9)
Mechanical ventilation requirement	95 (46.8)
Endotracheal intubation	94 (46.3)
Tracheostomy	14 (6.9)
ICU length of stay (days), mean (SD)	8.7 (12.5)
Hospital length of stay (days), mean (SD)	17.6 (23.8)
Mortality	52 (25.6)
Time: Floor-ICU admission (days), mean (SD)	2.9 (5.4)

ICU: Intensive care unit; ISS: Injury severity score.

Table 2 Characteristics comparison of upgrades and bounce backs, n (%)

Variable	Upgrades (n = 134)	Bounce backs (n = 69)	P value
Age (years) (mean)	72.4	67.5	0.1
Geriatric	99 (73.9)	42 (60.9)	0.1
Sex (male/female)	86 (64.2)/48 (35.8)	52 (75.4)/17 (24.6)	0.1
Comorbidities	126 (94.0)	60 (87.0)	0.1
Mechanism of injury	-	-	0.2
Fall	96 (71.6)	43 (62.3)	-
Motor vehicle	34 (25.4)	25 (36.2)	-
Other (assault, accident, and burn)	4 (3.0)	1 (1.4)	-
Glasgow Coma Scale (mean)	14.6	12.4	< 0.001^a
ISS (mean)	11.2	15.8	< 0.001^a
ISS ≥ 16	37 (27.6)	35 (50.7)	0.001^a
Main injury	-	-	0.003^a
Head-traumatic brain injury	42 (31.3)	34 (49.3)	-
Thorax	25 (18.7)	19 (27.5)	-
Spine	23 (17.2)	3 (4.3)	-
Hip/pelvis	17 (12.7)	5 (7.2)	-
Abdominal	5 (3.7)	6 (8.7)	-
Extremities	7 (5.2)	0 (0.0)	-
Facial	8 (6.0)	0 (0.0)	-
Cardiac	5 (3.7)	1 (1.4)	-
Pulmonary contusion	5 (3.7)	9 (13.0)	0.01^a
Pneumothorax	7 (5.2)	11 (15.9)	0.01^a
Hemothorax	12 (9.0)	14 (20.3)	0.02^a
Pneumohemothorax	4 (3.0)	7 (10.1)	0.03^a
Any blood transfusion	54 (40.3)	44 (63.8)	0.002^a
Any surgical procedure	60 (44.8)	36 (52.2)	0.3
Number of consultations (mean)	3.0	4.8	< 0.001^a
Mechanical ventilation requirement	51 (38.1)	44 (63.8)	0.001^a
Endotracheal intubation	50 (37.3)	44 (63.8)	< 0.001^a
Tracheostomy	6 (4.5)	8 (11.6)	0.1
ICU length of stay (days) (mean)	6.4	13.2	< 0.001^a
Hospital Length of Stay (days) (mean)	13.0	26.7	< 0.001^a
Mortality	28 (20.9)	24 (34.8)	0.03^a
Time: Floor-ICU admission (days) (mean)	2.0	4.5	< 0.001^a

^aDenotes a statistically significant difference (P < 0.05).

ICU: Intensive care unit; ISS: Injury severity score.

Table 3 Characteristics comparison of upgrades and bounce backs propensity score matched by injury severity score, n (%)

Variable	Upgrades (n = 61)	Bounce backs (n = 61)	P value
Age (years) (mean)	74.8	68.7	0.04^a
Geriatric	47 (77.0)	39 (63.9)	0.1
Sex (male/female)	41 (67.2)/20 (32.8)	45 (73.8)/16 (26.2)	0.4
Comorbidities	57 (93.4)	55 (90.2)	0.5
Mechanism of injury	-	-	0.9
Fall	41 (67.2)	40 (65.6)	-
Motor vehicle	19 (31.1)	20 (32.8)	-
Other (assault, accident, and burn)	1 (1.6)	1 (1.6)	-
Glasgow Coma Scale (mean)	14.7	12.8	< 0.001^a
ISS (mean)	13.9	13.8	0.5
ISS ≥ 16	27 (44.3)	27 (44.3)	1.0
Main injury	-	-	0.2
Head-traumatic brain injury	23 (37.7)	29 (47.5)	-
Thorax	12 (19.7)	19 (31.1)	-
Spine	7 (11.5)	3 (4.9)	-
Hip/pelvis	9 (14.8)	4 (6.6)	-
Abdominal	3 (4.9)	4 (6.6)	-
Extremities	2 (3.3)	0 (0.0)	-
Facial	3 (4.9)	0 (0.0)	-
Cardiac	1 (1.6)	1 (1.6)	-
Pulmonary contusion	3 (4.9)	7 (11.5)	0.2
Pneumothorax	2 (3.3)	9 (14.8)	0.03^a
Hemothorax	6 (9.8)	14 (23.0)	0.1
Pneumohemothorax	2 (3.3)	7 (11.5)	0.1
Any blood transfusion	26 (42.6)	38 (62.3)	0.03^a
Any surgical procedure	28 (45.9)	30 (49.2)	0.7
Number of consultations (mean)	3.1	4.6	< 0.001^a
Mechanical ventilation requirement	25 (41.0)	38 (62.3)	0.02^a
Endotracheal intubation	25 (41.0)	38 (62.3)	0.02^a
Tracheostomy	5 (8.2)	6 (9.8)	0.8
ICU length of stay (days) (mean)	6.1	11.3	< 0.001^a
Hospital length of stay (days) (mean)	12.5	21.7	< 0.001^a
Mortality	16 (26.2)	22 (36.1)	0.2
Time: Floor-ICU admission (days) (mean)	2.0	4.4	0.003^a

^aDenotes a statistically significant difference (P < 0.05).

ICU: Intensive care unit; ISS: Injury severity score.

Table 4 Characteristics comparison of geriatric and non-geriatric patients with unplanned intensive care unit admissions, n (%)

Variable	Geriatric (n = 141)	Non-geriatric (n = 62)	P value
Age (years) (mean)	81.8	45.5	< 0.001^a
Sex (male/female)	89 (63.1)/52 (36.9)	49 (79.0)/13 (21.0)	0.03^a
Comorbidities	139 (98.6)	47 (75.8)	< 0.001^a
Mechanism of injury	-	-	< 0.001^a
Fall	114 (80.9)	25 (40.3)	-
Motor vehicle	25 (17.7)	34 (54.8)	-
Other (assault, accident, and burn)	2 (1.4)	3 (4.8)	-
Glasgow Coma Scale	14.4	12.6	0.1
ISS (mean)	12.4	13.6	0.4
ISS ≥ 16	46 (32.6)	26 (41.9)	0.2
Upgrade/bounce back	99 (70.2)/42 (29.8)	35 (56.5)/27 (44.5)	0.1
Main injury-admission	-	-	0.005^a
Head-traumatic brain injury	56 (39.7)	20 (32.3)	-
Thorax	31 (22.0)	13 (21.0)	-
Spine	22 (15.6)	4 (6.5)	-
Hip/pelvis	14 (9.9)	8 (12.9)	-
Abdominal	2 (1.4)	9 (14.5)	-
Extremities	4 (2.8)	3 (4.8)	-
Facial	4 (2.8)	4 (6.5)	-
Cardiac	6 (4.3)	0 (0.0)	-
Pulmonary contusion	7 (5.0)	7 (11.3)	0.1
Pneumothorax	11 (7.8)	7 (11.3)	0.4
Hemothorax	22 (15.6)	4 (6.5)	0.1
Pneumohemothorax	8 (5.7)	3 (4.8)	0.8
Any blood transfusion	67 (47.5)	31 (50.0)	0.7
Any surgical procedure	52 (36.9)	44 (71.0)	< 0.001^a
Number of consultations (mean)	3.5	3.9	0.4
Mechanical ventilation requirement	52 (36.9)	43 (69.4)	< 0.001^a
Endotracheal intubation	51 (36.2)	43 (69.4)	< 0.001^a
Tracheostomy	7 (5.0)	7 (11.3)	0.1
ICU length of stay (days) (mean)	6.8	13.1	0.02^a
Hospital length of stay (days) (mean)	13.1	27.9	< 0.001^a
Mortality	45 (31.9)	7 (11.3)	0.002^a
Time: Floor-ICU admission (days) (mean)	2.1	4.7	0.2

^aDenotes a statistically significant difference (P < 0.05).

ICU: Intensive care unit; ISS: Injury severity score.

Table 5 Characteristics of patients with unplanned intensive care unit admissions due to respiratory complications, n (%)

Variable	Respiratory complications (n = 80)
Age (yaers) (mean)	69.0
Geriatric	52 (65.0)
Sex (male/female)	53 (66.3)/27 (32.7)
Comorbidities	72 (90.0)
Mechanism of injury	-
Fall	50 (62.5)
Motor vehicle	28 (35.0)
Glasgow Coma Scale (mean)	14.3
ISS (mean)	11.9
ISS ≥ 16	22 (27.5)
Upgrade/bounce back	30 (37.5)/50 (62.5)
Main injury	-
Head-traumatic brain injury	16 (20.0)
Thorax	26 (32.5)
Spine	14 (17.5)
Hip/pelvis	9 (11.3)
Abdominal	5 (6.3)
Extremities	3 (3.8)
Facial	5 (6.3)
Pulmonary contusion	7 (8.8)
Pneumothorax	10 (12.5)
Hemothorax	15 (18.8)
Pneumohemothorax	6 (7.5)
Any blood transfusion	39 (48.8)
Any surgical procedure	43 (53.8)
Number of consultations (mean)	3.9
Mechanical ventilation requirement	54 (67.5)
Endotracheal intubation	53 (66.3)
Tracheostomy	13 (16.3)
ICU length of stay (days) (mean)	12.8
Hospital length of stay (days) (mean)	21.1
Mortality	24 (30.0)
Time: Floor-ICU admission (days) (mean)	4.0

ICU: Intensive care unit; ISS: Injury severity score.

Citation: Fokin AA, Wycech Knight J, Gallagher PK, Xie JF, Brinton KC, Tharp ME, Puente I. Characteristics and outcomes of trauma patients with unplanned intensive care unit admissions: Bounce backs and upgrades comparison. World J Crit Care Med 2025; 14(2): 101957
URL: https://www.wjgnet.com/2220-3141/full/v14/i2/101957.htm
DOI: https://dx.doi.org/10.5492/wjccm.v14.i2.101957