GS15 - Factors Impacting Prolonged ICU Stay in Patients with Mild Traumatic Brain Injury

Introduction/Purpose: Patients with mild traumatic brain injury (mTBI) are often transferred from smaller hospitals to Level 1 and 2 trauma centers for Intensive Care Unit (ICU) admissions. However, in many cases, these patients are transferred out of the ICU or discharged within 24 hours. With limited ICU beds and high costs of care, this study aims to investigate risk factors associated with prolonged ICU stays to determine which patients may require intensive care upon admission.

Methods or Case Description: A retrospective chart review was performed on 1520 patients with mTBI defined as Glasgow Coma Score (GCS) of 13-15 who presented to a level 1 trauma center from Oct 2015- Sep 2019 with initial Computed Tomography head (CTH) demonstrating intracranial hemorrhage (ICH). Odds Ratio is calculated and Chi-Square test is used to determine significance

Outcomes: Among 1520 patients who presented with mTBI, 1261 (82.96%) were admitted to the ICU. Of those, 880 (69.8%) were transferred to a lower level of care within 24 hours. The highest risk factors that led to prolonged ICU admissions were ICH requiring neurosurgical intervention (OR= 80.78; P< 0.001) and evidence of midline shift (OR= 4.48; P< 0.001). Other factors include paresis (OR= 2.53; P=0.003), confusion (OR=1.72; P< 0.001), warfarin therapy (OR= 2.37; P< 0.001), subdural hemorrhage (OR= 1.77; P< 0.001), and intraparenchymal hemorrhage (OR= 1.80; P< 0.001).

Conclusion: Prolonged ICU admissions were most likely in patients requiring neurosurgical intervention and presence of midline shift on CTH. Other contributory factors include anticoagulation therapy, symptoms of confusion and paresis upon admission, and types of intracranial hemorrhage.