Risk factors and predictive value for prolonged length of ICU stay among trauma patients

Zhong Lixia; Jin Yanhong; Li Shuo; Zheng Yulin; Zhang Weiwei

doi:10.3969/j.issn.1009-4237.2024.11.011

Abstract：Objective To explore the risk factors of prolonged length of stay in ICU(ICU-LOS)among trauma patients,and to analyze the predictive value of these factors.Methods A retrospective cohort study was con-ducted.The general demographic and clinical data of 126 trauma patients admitted in the Department of Intensive Care Medicine of Beijing Friendship Hospital,Capital Medical University from Jan.2018 to Nov.2023 were collect-ed.Among them,there were 94 males and 32 females aged 18-92 years,with a median age of 51 years.The injury mechanisms were car accidents in 48 cases,ground-level falls in 31,sharp instrument injuries in 19,falls from height in 16,and blunt injuries in 12.Based on the ICU-LOS,patients were divided into prolonged group(＞4 d,n=59)and non-prolonged group(≤ 4 d,n=67).Univariate analysis and binary logistic regression analysis were used to screen the influencing factors;the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of these factors.Results Of the 126 patients,59 had prolonged ICU-LOS,with the prevalence being 46.83％.Uni-variate analysis showed that compared with the non-prolonged group,the prolonged group showed higher body tem-perature[℃,36.6(36.0,37.0)vs.36.3(36.0,36.7)],higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores(18.3±8.4 vs.12.4±4.9),longer duration of invasive mechanical ventilation[h,100.00(9.00,248.00)vs.2.00(0.17,10.00)],larger proportions of patients with craniocerebral injuries(59.3％vs.26.9％)and longer overall length of hospitalization[d,22(15,28)vs.12(7,23)],all P＜0.05,whereas much less red blood cell(RBC)count(x 1012/L,3.38±0.73 vs.3.69±0.65)and platelet(PLT)count[x 109/L,146(95,195)vs.174(133,217)],and lower Glasgow coma scale/scores[GCS,9(4,14)vs.15(14,15)],all P＜0.05.Binary logistic regression analysis revealed that the duration of invasive mechanical ventilation(OR=1.039,95％CI=1.021-1.058)and RBC count(OR=0.380,95％CI=0.178-0.811)were independent influencing factors for prolonged ICU-LOS in trauma patients;the area under the ROC curve(AUC)was 0.794(95％CI=0.713-0.861)for duration of invasive mechanical ventilation and 0.618(95％CI％=0.527-0.703)for RBC(both P＜0.05).The combined predictive value of the two variables was higher,with the AUC being 0.880(95％CI=0.810-0.931,P＜0.001).Conclusion Long duration of invasive mechanical ventilation and low RBC count independently prolong ICU-LOS in trauma patients.A combination of the two variables to predict a prolonged ICU-LOS in trauma patients has better efficacy than any alone.