Outcome following prolonged intensive care unit stay in multiple trauma patients.

OBJECTIVE: To describe the hospital course and outcomes of trauma patients requiring ICU stays greater than 30 days and the charges they incur.
DESIGN: A retrospective case series analysis of data collected from patient charts and trauma registry.
SETTING: A Level I regional trauma center that is part of a statewide trauma system. PATIENTS: Over a 3-yr period, 87 patients (3% of all trauma ICU admissions) had prolonged stays (greater than 30 days) in the ICU; they constitute the study group. Blunt trauma was responsible for 90% of injuries, and the mean Injury Severity Score was 34 +/- 16 SD.
RESULTS: Mechanical ventilation was required for 78.5% of the time spent in the ICU. The mean time spent on mechanical ventilators was 47 +/- 23 days; in the ICU, 60 +/- 27 days; and in the hospital, 72 +/- 29 days. Infectious complications occurred in 90% and organ dysfunction was seen in 76% of patients. The overall mortality rate was 17.2% (31% for patients greater than 65 yr). Patients less than 40 yr had lower mortality rates despite a significantly higher Injury Severity Score and lower Glasgow Coma Scale score compared with those greater than 65 yr. More patients greater than 65 yr were discharged to chronic care facilities than those younger (23% vs. 5%). The number of patients followed at 3 and 12 months after discharge was 74% and 54%, respectively, with only two deaths. The mean hospital and professional charges to the patients were $101,000 +/- 61,000 and $35,000 +/- 13,000, respectively.
CONCLUSION: Length of ICU stay was most closely associated with the need for mechanical ventilation. The presence of premorbid illness, age greater than 65 yr, and organ dysfunction was associated with increased mortality. Although trauma patients requiring prolonged ICU stays utilize many resources, the ultimate outcome may be fairly good.