Evaluation of critical care burden following traumatic injury from two randomized controlled trials

Insiyah Campwala; Francis X Guyette; Joshua B Brown; Mark H Yazer; Brian J Daley; Richard S Miller; Brian G Harbrecht; Jeffrey A Claridge; Herbert A Phelan; Brian Eastridge; Raminder Nirula; Gary A Vercruysse; Terence O'Keeffe; Bellal Joseph; Matthew D Neal; Brian S Zuckerbraun; Jason L Sperry

doi:10.1038/s41598-023-28422-5

Evaluation of critical care burden following traumatic injury from two randomized controlled trials

Sci Rep. 2023 Jan 20;13(1):1106. doi: 10.1038/s41598-023-28422-5.

Authors

Insiyah Campwala¹, Francis X Guyette², Joshua B Brown¹, Mark H Yazer³, Brian J Daley⁴, Richard S Miller⁵, Brian G Harbrecht⁶, Jeffrey A Claridge⁷, Herbert A Phelan⁸, Brian Eastridge⁹, Raminder Nirula¹⁰, Gary A Vercruysse¹¹, Terence O'Keeffe¹¹, Bellal Joseph¹¹, Matthew D Neal¹, Brian S Zuckerbraun¹, Jason L Sperry¹²

Affiliations

¹ Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, 200 Lothrop St., Pittsburgh, PA, 15213, USA.
² Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
³ The Institute for Transfusion Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Surgery, University of Tennessee Health Science Center, Knoxville, TN, USA.
⁵ Department of Surgery, JPS Health Network, Fort Worth, TX, USA.
⁶ Department of Surgery, University of Louisville, Louisville, KY, USA.
⁷ Department of Surgery, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
⁸ Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
⁹ Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
¹⁰ Department of Surgery, University of Utah, Salt Lake City, UT, USA.
¹¹ Department of Surgery, University of Arizona, Tucson, AZ, USA.
¹² Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh, 200 Lothrop St., Pittsburgh, PA, 15213, USA. sperryjl@upmc.edu.

Abstract

Trauma resuscitation practices have continued to improve with new advances targeting prehospital interventions. The critical care burden associated with severely injured patients at risk of hemorrhage has been poorly characterized. We aim to describe the individual and additive effects of multiorgan failure (MOF) and nosocomial infection (NI) on delayed mortality and resource utilization. A secondary analysis of harmonized data from two large prehospital randomized controlled trials (Prehospital Air Medical Plasma (PAMPer) Trial and Study of Tranexamic Acid during Air and Ground Medical Prehospital Transport (STAAMP) Trial) was conducted. Only those patients who survived beyond the first 24 hours post-injury and spent at least one day in the ICU were included. Patients were stratified by development of MOF only, NI only, both, or neither and diagnosis of early (≤ 3 days) versus late MOF (> 3 days). Risk factors of NI and MOF, time course of these ICU complications, associated mortality, and hospital resource utilization were evaluated. Of the 869 patients who were enrolled in PAMPer and STAAMP and who met study criteria, 27.4% developed MOF only (n = 238), 10.9% developed NI only (n = 95), and 15.3% were diagnosed with both MOF and NI (n = 133). Patients developing NI and/or MOF compared to those who had an uncomplicated ICU course had greater injury severity, lower GCS, and greater shock indexes. Early MOF occurred in isolation, while late MOF more often followed NI. MOF was associated with 65% higher independent risk of 30-day mortality when adjusting for cofounders (OR 1.65; 95% CI 1.04-2.6; p = 0.03), however NI did not significantly affect odds of mortality. NI was individually associated with longer mechanical ventilation, ICU stay, hospital stay, and rehabilitation requirements, and the addition of MOF further increased the burden of inpatient and post-discharge care. MOF and NI remain common complications for those who survive traumatic injury. MOF is a robust independent predictor of mortality following injury in this cohort, and NI is associated with higher resource utilization. Timing of these ICU complications may reveal differences in pathophysiology and offer targets for continued advancements in treatment.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aftercare*
Critical Care
Humans
Patient Discharge*
Randomized Controlled Trials as Topic
Resuscitation