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Race and Other Factors Affecting Unplanned ICU Admission at a Level 1 Trauma Center
Sarah Chen, MD, Edward Kelly, MD, FACS, Jacques Townsend, DO, Reginald Alouidor, MD, FACS, Tovy Haber Kamine, MD, MBA, FACS
Baystate Medical Center, Springfield, MA
Background: Unplanned ICU (UP-ICU) admission in trauma patients is associated with worse outcomes. Non-white race has been shown to be an independent predictor for worse health outcomes. We aimed to determine if race or other factors predict UP-ICU admission at an urban level 1 trauma center (L1TC), specifically patients admitted to stepdown unit.
Methods: Retrospective cohort study was performed utilizing the traumaOne database of all trauma patients from 11/1/2021 to 10/31/2023 at an L1TC. Univariate logistic regression analysis used to determine predictors of UP-ICU admission. Factors significant in univariate analysis included in a multivariable logistic regression model.
Results: 3338 patients included (512 non-white, 1373 daytime admissions), 106 had UP-ICU admission (3.18%). 603 patients were initially admitted to the step down unit which had an unplanned ICU admission rate of 8.12%. Multivariable logistic regression model demonstrated: comorbid COPD (OR 5.46 p<0.0001), need for supplemental oxygen (OR 4.33 p<0.0001), presence of facial injury (OR 3.98 p<0.0001), 40-64 year old patients (OR ?3.24 p=0.0005), patients initially admitted to non-trauma teams (OR 2.66 p=0.0136), non-white patients (OR 2.48 p=0.0206), and initial daytime admissions (OR 2.05 p=0.0298) significant.
Conclusion: Multiple factors predict unplanned ICU admission, including race. These data suggest a bias in determination of stepdown vs. ICU admission—patients who are over 65, white, and admitted overnight may be more likely to be admitted to ICU, avoiding UP-ICU admission. Vigilance is necessary about the effects of underlying bias in admissions decisions.
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