MORTALITY RATE IS HIGHER IN EARLY TRAUMA ICU BOUNCE BACK PATIENTS THAN IN LATE ICU BOUNCE BACK PATIENTS

Objectives: Unplanned readmission to the ICU ("bounce back”) is associated with increased mortality and is a required performance improvement indicator for ACS-verified Level I Trauma Centers. We define ICU bounce back (ICU-BB) as patients admitted to the ICU from the ED, subsequently discharged to floor care, then readmitted to ICU. Few studies regarding ICU-BB are available in trauma populations. Our primary objective was to determine the impact of early ICU readmission ( < 72 hrs from discharge) on mortality and to identify clinical factors which contribute to early ICU-BB.

Methods: IRB-approved (IRB number 4519) retrospective review of trauma patients admitted to ICU in a single, academic ACS-verified Level I Trauma Center from January 2019 to December 2021. 175 patients met the criteria for inclusion. Age range: 16 to 92 (mean=60.98 +/-20.97). The most common mechanism of injury was falling, followed by MVC. Average ISS score was 19.98 +/- 9.091. Patients were assessed in 2 groups: early ICU-BB (n=101) and late ICU-BB (n=74). Bivariate and multivariate analyses of variables were performed on SPSS, version 28 (IBM Corp).

Results: Early ICU-BB mortality rate was 2.8 times higher than late ICU-BB (p=.024). Patients with surgical procedures lasting greater than two hours during their initial ICU stay experienced more frequent early ICU-BB (p=.03). The average initial ICU length of stay in the early group was 2.7 days compared to 8.6 days in late ICU-BB (p= <.001). Open abdominal procedures (p=.07) and cardiac dysrhythmia during initial ICU stay (p=.096) approached statistical significance in the early ICU-BB group. There was no statistically significant difference in other screened variables (ISS, AIS scores, opiate utilization, WBC count/trends, COVID-19 ICU demand.)

Conclusion: Early ICU-BB patients have a considerably higher risk of mortality compared to those who bounce back after 72 hours. Enhanced scrutiny for discharge from the ICU is recommended for patients undergoing surgical procedures of more than 2 hours duration, undergoing open abdominal procedures, and/or experiencing cardiac dysrhythmias during the initial ICU admission. Our study was limited by its retrospective design and being limited to a single center. Additional prospective research is needed to achieve a more granular approach to identification of variables associated with early ICU-BB. This would allow trauma teams to develop practice guidelines that reduce frequency, morbidity, and mortality associated with both early and overall ICU bounce backs in the trauma population.-