Factors Predicting Intensive Care Unit Admission in Trauma Patients: A Multicenter Study Based on the National Trauma Registry of Iran
-
Mohammadreza Golbakhsh
,
Seyed Aref Daneshi
,
Tina Azimzadeh
,
Amirmohammad Sharafi
,
Mehrdad Sheikhvatan
,
Seyed Hossein Shafiei
Abstract
Background: Caring for trauma patients is a paramount international concern. Delays in diagnosing patients in need of intensive care have unredeemable consequences. Identifying predicting factors of ICU admission in trauma patients is not without merit regarding this matter. This study aimed to investigate the underlying factors associated with ICU admission in trauma patients.
Methods: A retrospective study was designed based on data from the National Trauma Registry of Iran from 2016 to 2021. ICU admission was considered the primary endpoint. Relationships between demographic variables, injury site, injury mechanism, vital signs, and trauma scores with the outcome were evaluated by univariate analyzes. ICU risk factors and their specific odds ratio were determined by multivariate analysis.
Results: Following univariate and multivariate analysis, age> 55 years, widowhood, injuries due to road accidents, falling from a height, penetrating objects, and gunshot, underlying cardiovascular disease, injury to head, thorax, abdomen, spine, and lower extremities, hypotension, hypertension, tachycardia, bradycardia, hyperpnea, low oxygen saturation, high body temperature, GCS≤8, and ISS>15 were introduced as independent risk factors of ICU admission. Nonetheless, transport to the hospital (personal car) and upper extremity injury reduced the outcome incidence.
Conclusions: Numerous contextual variables were significantly associated with ICU admission, each with its own matter. When entering the emergency room, paying attention to these factors can help diagnose people in need of ICU care sooner.
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2. Hofman K, Primack A, Keusch G, Hrynkow S. Addressing the growing burden of trauma and injury in low- and middle- income countries. Am J Public Health. 2005;95(1):13-7. doi: 10.2105/ajph.2004.039354. [PubMed: 15623852]. [PubMed Central: PMC1449844].
3. Lockey DJ. Improved Trauma Outcomes after the Introduction of a Trauma System in England. EClinicalMedicine. 2018;2-3:3-4. doi: 10.1016/j.eclinm.2018.08.002. [PubMed: 31193587]. [PubMed Central: PMC6537564].
4. Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13-21. doi: 10.1097/sla.0000000000000600. [PubMed: 24651132].
5. Sobrino J, Shafi S. Timing and causes of death after injuries. Proc (Bayl Univ Med Cent). 2013;26(2):120-3. doi: 10.1080/08998280.2013.11928934. [PubMed: 23543966]. [PubMed Central: PMC3603725].
6. Teixeira PG, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63(6):1338-46; discussion 46-7. doi: 10.1097/TA.0b013e31815078ae. [PubMed: 18212658].
7. Bazargan-Hejazi S, Ahmadi A, Shirazi A, Ainy E, Djalalinia S, Fereshtehnejad SM, et al. The Burden of Road Traffic Injuries in Iran and 15 Surrounding Countries: 1990-2016. Arch Iran Med. 2018;21(12):556-65. [PubMed: 30634852].
8. Hashemi E, Zangi M, Sadeghi-Bazargani H, Soares J, Viitasara E, Mohammadi R. Population-based epidemiology of non-fatal injuries in Tehran, Iran. Health Promot Perspect. 2018;8(2): 127-32. doi: 10.15171/hpp.2018.16. [PubMed: 29744308]. [PubMed Central: PMC5935816].
9. Sehat Z, Fakharian E, Sehat M, Omidi A. Epidemiology pattern of traumatic injuries of adults older than 15 years in Kashan, Iran: A population-based study in 2018-2019. Med J Islam Repub Iran. 2021;35:62. doi: 10.47176/mjiri.35.62. [PubMed: 34277499]. [PubMed Central: PMC8278027].
10. Saadat S, Yousefifard M, Asady H, Moghadas Jafari A, Fayaz M, Hosseini M. The Most Important Causes of Death in Iranian Population; a Retrospective Cohort Study. Emerg (Tehran). 2015;3(1):16-21. [PubMed: 26512364]. [PubMed Central: PMC4614603].
11. Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270-6. doi: 10.1016/j.jcrc.2016.07.015. [PubMed: 27612678].
12. Smith G, Nielsen M. ABC of intensive care. Criteria for admission. BMJ. 1999;318(7197):1544-7. doi: 10.1136/bmj.318.7197.1544. [PubMed: 10356016]. [PubMed Central: PMC1115908].
13. Kılıç M, Yüzkat N, Soyalp C, GülhaşN. Cost Analysis on Intensive Care Unit Costs Based on the Length of Stay. Turk J Anaesthesiol Reanim. 2019;47(2):142-5. doi: 10.5152/tjar.2019.80445. [PubMed: 31080956]. [PubMed Central: PMC6499040].
14. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-71. doi: 10.1097/01.ccm.0000164543.14619.00. [PubMed: 15942342].
15. Van Zyl A, Ahmed N, Davids R. The trauma burden on a tertiary surgical intensive care unit during the lockdown period in South Africa: A retrospective observational study. Trauma. 2021;24(4):146040862110191. doi: 10.1177/14604086211019163.
16. Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj Epidemiol. 2016;3(1):18. doi: 10.1186/s40621- 016-0084-5. [PubMed: 27747555]. [PubMed Central: PMC4974260].
17. Sartorius D, Le Manach Y, David JS, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38(3):831-7. doi: 10.1097/CCM.0b013e3181cc4a67. [PubMed: 20068467].
18. Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017;17(1):77. doi: 10.1186/s12893-017-0272-4. [PubMed: 28673278]. [PubMed Central: PMC5496419].
19. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15(4):R191. doi: 10.1186/cc10348. [PubMed: 21831280]. [PubMed Central: PMC3387633].
20. Singh J, Gupta G, Garg R, Gupta A. Evaluation of trauma and prediction of outcome using TRISS method. J Emerg Trauma Shock. 2011;4(4):446-9. doi: 10.4103/0974-2700.86626. [PubMed: 22090735]. [PubMed Central: PMC3214498].
21. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007;35(6):1477-83. doi: 10.1097/01.Ccm.0000266585.74905.5a. [PubMed: 17440421].
22. Serviá L, Badia M, Baeza I, Montserrat N, Justes M, Cabré X, et al. Time spent in the emergency department and mortality rates in severely injured patients admitted to the intensive care unit: An observational study. J Crit Care. 2012;27(1):58-65. doi: 10.1016/j.jcrc.2011.07.001. [PubMed: 21958981].
23. Aletreby WT, Brindley PG, Balshi AN, Huwait BM, Alharthy AM, Madi AF, et al. Delayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study. Rev Bras Ter Intensiva. 2021;33(1):125-37. doi: 10.5935/0103-507x.20210014. [PubMed: 33886862]. [PubMed Central: PMC8075331].
24. Wu SC, Chou SE, Liu HT, Hsieh TM, Su WT, Chien PC, et al. Performance of Prognostic Scoring Systems in Trauma Patients in the Intensive Care Unit of a Trauma Center. Int J Environ Res Public Health. 2020;17(19):7226. doi: 10.3390/ijerph17197226. [PubMed: 33023234]. [PubMed Central: PMC7578952].
25. Saeednejad M, Zafarghandi M, Khalili N, Baigi V, Khormali M, Ghodsi Z, et al. Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran. Chin J Traumatol. 2021;24(3):153-8. doi: 10.1016/j.cjtee.2021.01.009. [PubMed: 33640244]. [PubMed Central: PMC8173574].
26. Sharif-Alhoseini M, Zafarghandi M, Rahimi-Movaghar V, Heidari Z, Naghdi K, Bahrami S, et al. National Trauma Registryof Iran: A Pilot Phase at a Major Trauma Center in Tehran. Arch
Iran Med. 2019;22(6):286-92. [PubMed: 31356094].
27. Yadollahi M. A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017. Chin J Traumatol. 2019;22(4):212-8. doi: 10.1016/j.cjtee.2019.01.012. [PubMed:
31239216]. [PubMed Central: PMC6667929].
28. MacKenzie EJ, Shapiro S, Eastham JN. The Abbreviated Injury
Scale and Injury Severity Score. Levels of inter- and intrarater reliability. Med Care. 1985;23(6):823-35. doi: 10.1097/00005650- 198506000-00008. [PubMed: 3925257].
29. Samin OA, Civil ID. The new injury severity score versus the injury severity score in predicting patient outcome: a comparative evaluation on trauma service patients of the Auckland Hospital. Annu Proc Assoc Adv Automot Med. 1999;43:1-15. [PubMed Central: PMC3400229].
30. Chiang YT, Lin TH, Hu RH, Lee PC, Shih HC. Predicting factors for major trauma patient mortality analyzed from trauma registry system. Asian J Surg. 2021;44(1):262-8. doi: 10.1016/j.asjsur.2020.06.014. [PubMed: 32859471].
31. Bing-Hua YU. Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg. 2014;208(2):268-74. doi: 10.1016/j.amjsurg.2013.08.044. [PubMed: 24480235].
32. Soni KD, Kaushik G, Gupta A, Singh V, Kumar S, Sagar S. From Emergency Department to Intensive Care Unit, Does The Delay Matter to Trauma Patients? J Emerg Trauma Shock. 2018;11(3):189-92. doi: 10.4103/jets.Jets_132_17. [PubMed: 30429626]. [PubMed Central: PMC6182966].
33. Haider A, Con J, Prabhakaran K, Anderson P, Policastro A, Feeney J, et al. Developing a Simple Clinical Score for Predicting Mortality and Need for ICU in Trauma Patients. Am Surg. 2019;85(7):733-7. [PubMed: 31405418].
34. Lavoie A, Moore L, LeSage N, Liberman M, Sampalis JS. The Injury Severity Score or the New Injury Severity Score for predicting intensive care unit admission and hospital length of stay? Injury. 2005;36(4):477-83. doi: 10.1016/j.injury.2004.09.039. [PubMed: 15755427].
35. Lin FC, Tsai SC, Li RY, Chen HC, Tung YW, Chou MC. Factors associated with intensive care unit admission in patients with traumatic thoracic injury. J Int Med Res. 2013;41(4):1310-7. doi: 10.1177/0300060513489921. [PubMed: 23857159].
36. Barry R, Thompson E. Outcomes after rib fractures in geriatric blunt trauma patients. Am J Surg. 2018;215(6):1020-3. doi: 10.1016/j.amjsurg.2018.03.011. [PubMed: 29548528].
37. Bellone A, Bossi I, Etteri M, Cantaluppi F, Pina P, Guanziroli M, et al. Factors Associated with ICU Admission following Blunt Chest Trauma. Can Respir J. 2016;2016:3257846. doi: 10.1155/2016/3257846. [PubMed: 28044070]. [PubMed Central: PMC5156815].
38. Kong G, Yin X, Wang T, Body R, Chen YW, Wang J, et al. Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital. Injury. 2015;46(9):1784-9. doi: 10.1016/j.injury.2015.06.002. [PubMed: 26093963].
39. Mehl SC, Cunningham ME, Streck CJ, Pettit R, Huang EY, Santore MT, et al. Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma. Pediatr Surg Int. 2022;38(4):589-97. doi: 10.1007/s00383-022- 05067-5. [PubMed: 35124723]. [PubMed Central: PMC9087985].
40. Zeelenberg ML, Den Hartog D, Halvachizadeh S, Pape HC, Verhofstad MHJ, Van Lieshout EMM. The impact of upper- extremity injuries on polytrauma patients at a level 1 trauma center. J Shoulder Elbow Surg. 2022;31(5):914-22. doi: 10.1016/j.jse.2021.10.005. [PubMed: 34687916].
41. Farrath S, Parreira JG, Perlingeiro JA, Solda SC, Assef JC. Predictors of abdominal injuries in blunt trauma. Rev Col Bras Cir. 2012;39(4):295-301. doi: 10.1590/s0100-69912012000400009. [PubMed: 22936228].
42. Chu D, Lee YH, Lin CH, Chou P, Yang NP. Prevalence of associated injuries of spinal trauma and their effect on medical utilization among hospitalized adult subjects--a nationwide data-based study. BMC Health Serv Res. 2009;9:137. doi: 10.1186/1472-6963-9-137. [PubMed: 19650923]. [PubMed Central: PMC2729309].
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| Files | ||
| Issue | Vol 12 No 1 (2026) | |
| Section | Research Articles | |
| Keywords | ||
| Wounds and Injuries Intensive Care Units Emergency Hospital Service Vital Signs Risk Factors | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Golbakhsh M, Daneshi SA, Azimzadeh T, Sharafi A, Sheikhvatan M, Shafiei SH. Factors Predicting Intensive Care Unit Admission in Trauma Patients: A Multicenter Study Based on the National Trauma Registry of Iran. J Orthop Spine Trauma. 2026;12(1):43-9.
