Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: A retrospective pre-post study

J Trauma Acute Care Surg. 2020 Apr;88(4):515-521. doi: 10.1097/TA.0000000000002588.


Background: Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes.

Methods: We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a Level I trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models.

Results: Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 years to 92 years (mean, 49.0 ± 20.4 years) and 74.3% were men. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p = 0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (odds ratio, 0.43; 95% confidence interval, 0.24-0.79; p = 0.006) or in-hospital (odds ratio, 0.55; 95% confidence interval; 0.32-0.94; p = 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups.

Conclusion: Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.

Level of evidence: Therapeutic, level III.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Clinical Protocols*
  • Critical Care / methods
  • Critical Care / organization & administration*
  • Critical Illness / rehabilitation
  • Early Ambulation*
  • Female
  • Health Plan Implementation
  • Hospital Mortality
  • Humans
  • Injury Severity Score
  • Intensive Care Units / organization & administration*
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nova Scotia / epidemiology
  • Program Evaluation
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Tertiary Care Centers / organization & administration
  • Tertiary Care Centers / statistics & numerical data
  • Trauma Centers / organization & administration
  • Trauma Centers / statistics & numerical data
  • Treatment Outcome
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*