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Association of Hospital-Level Intensive Care Unit Use and Outcomes in Older Patients With Isolated Rib Fractures
- Source :
- JAMA Network Open
- Publication Year :
- 2020
- Publisher :
- American Medical Association, 2020.
-
Abstract
- Key Points Question Is a greater hospital-level tendency to admit older patients with rib fractures as an isolated injury to the intensive care unit (ICU) associated with improved outcomes for those patients? Findings In this cohort study of 23 951 patients aged 65 years and older, ICU use per trauma center varied from 0% to 92% of patients with isolated rib fractures. Greater ICU use was associated with a reduction in a composite adverse outcome of death, unplanned intubation, or pneumonia. Meaning These findings suggest that admission to an ICU may improve the outcomes of older patients with isolated chest wall injuries.<br />This cohort study characterizes interhospital variability in intensive care unit vs non–intensive care unit admission of older patients with isolated rib fractures and evaluates whether greater hospital-level use of intensive care units is associated with improved outcomes.<br />Importance The optimal level of care for older patients with rib fractures as an isolated injury is unknown. Objectives To characterize interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and to evaluate whether greater hospital-level use of ICU admission is associated with improved outcomes. Design, Setting, and Participants This cohort study included trauma patients aged 65 years and older with isolated rib fractures who were admitted to US trauma centers participating in the National Trauma Data Bank between January 1, 2015, and December 31, 2016. Patients were excluded if they had other significant injuries, were intubated or had assisted respirations in the emergency department (ED), or had a Glasgow Coma Scale (GCS) score of less than 9 in the ED. Hospitals with fewer than 10 eligible patients were excluded. Data analysis was conducted from May 2019 through September 2020. Exposures Admission to the ICU. Main Outcomes and Measures Composite of unplanned intubation, pneumonia, or death during hospitalization. Results Among 23 951 patients (11 066 [46.2%] women; mean [SD] age, 77.0 [7.2] years) at 573 hospitals, the median (interquartile range) proportion of ICU use was 16.7% (7.4%-32.0%), but this varied from a low of 0% to a high of 91.9%. The composite outcome occurred in 787 patients (3.3%), with unplanned intubation in 317 (1.3%), pneumonia in 180 (0.8%), and death in 451 (1.9%). Accounting for the hierarchical nature of the data and adjusting for propensity scores reflecting factors associated with ICU admission, receiving care at a hospital with the greatest ICU use (quartile 4), compared with a hospital with the lowest ICU use, was associated with decreased likelihood of the composite outcome (adjusted odds ratio, 0.71; 95% CI, 0.55-0.92). Conclusions and Relevance In this study, admission location of older patients with isolated rib fractures was variable across hospitals, but hospitalization at a center with greater ICU use was associated with improved outcomes. It may be warranted for hospitals with low ICU use to admit more such patients to an ICU.
- Subjects :
- Male
medicine.medical_specialty
Rib Fractures
medicine.medical_treatment
law.invention
Cohort Studies
Trauma Centers
Interquartile range
law
medicine
Intubation, Intratracheal
Odds Ratio
Intubation
Humans
Hospital Mortality
Propensity Score
Original Investigation
Aged
Retrospective Studies
Aged, 80 and over
Respiratory Distress Syndrome
business.industry
Research
Glasgow Coma Scale
General Medicine
Odds ratio
Emergency department
Pneumonia
Intensive care unit
Hospitals
Hospitalization
Online Only
Intensive Care Units
Propensity score matching
Emergency medicine
Abbreviated Injury Scale
Surgery
Female
business
Cohort study
Subjects
Details
- Language :
- English
- ISSN :
- 25743805
- Volume :
- 3
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- JAMA Network Open
- Accession number :
- edsair.doi.dedup.....0a304baa236111a58011bd3ad8badfa2