Prolonged ICU stay and its association with 1-year trauma mortality: An analysis of 19,000 American patients

Introduction: Prior research on patients with traumatic injury suggests high in-hospital survivability. However, little is known about their long-term outcomes, especially in the context of a prolonged ICU length-of-stay (LOS). We sought to determine the association between prolonged ICU-LOS and 1-year survival in trauma patients. Methods: TRICARE claims data (2011–2015) were queried for trauma patients with an Injury Severity Score > 9. Risk-adjusted Cox models were used to determine the influence of prolonged ICU LOS on 1-year mortality. Results: Of 19,155 patients included, 40% were admitted to the ICU. The overall 1-year mortality was 3.9% and 4.7% in patients with ICU LOS >9 days. In the multivariable model older age (55–64 vs. 18–24 years) (HR: 47.8, CI:20.8–109.9), prior comorbidities (>1 vs. 0) (HR: 2.6, CI: 2.1–3.2), discharge disposition (transfer vs discharge) (HR: 2.3 CI: 1.7–3.1) and ICU-LOS (>7 vs. 1 days) (HR:2.6, CI:1.7–4.0) were associated with 1-year mortality. Conclusion: Prolonged ICU-LOS is a risk factor for 1-year mortality in trauma patients. But an overall high survival (>96%) reinforces the justification for such use of the ICU in trauma patients when clinically necessary.