• Marko Bukur, Fahim Habib, Joe Catino, Michael Parra, Robyn Farrington, Maggie Crawford, and Ivan Puente.
• From the Division of Trauma and Surgical Critical Care (M.B., J.C., M.P., M.C., I.P.), Department of Surgery, Delray Medical Center, Delray Beach; Division of Trauma and Surgical Critical Care (M.B., F.H., J.C., M.P., R.F., I.P.), Department of Surgery, Broward General Medical Center, Fort Lauderdale; Herbert Wertheim College of Medicine (M.B., F.H., I.P.), Florida International University, University Park; and Charles E Schmidt College of Medicine (M.B., I.P.), Florida Atlantic University, Boca Raton, Florida.
• J Trauma Acute Care Surg. 2015 May 1;78(5):920-7; discussion 927-9.

BackgroundRecent data suggest that specialty intensive care units (ICUs) have outcomes better than those of mixed ICUs. The cause for this apparent discrepancy has not been well established. We hypothesized that trauma patients admitted to a dedicated trauma ICU (TICU) would have a lower complication rate as well as death after complication (failure to rescue [FTR]).MethodsThis was a retrospective review of the ICUs of two Level I trauma centers covered by one group of surgical intensivists. One center has a dedicated TICU, while the other has a mixed ICU. Demographic and clinical characteristics were stratified into TICU and ICU groups. The primary outcomes were postinjury complications and FTR. Multivariate regression was used to derive factors associated with complications and FTR.ResultsDuring the 5-year study period, 3,833 patients were analyzed. TICU patients were older (57.8 vs. 47.0 years, p < 0.0001), had higher Charlson score (2 vs. 1, p = 0.001), had more severe head injuries (Head Abbreviated Injury Scale [AIS] score ≥ 3, 50.0% vs. 37.5%, p < 0.0001), and had greater injury burden (Injury Severity Score [ISS] > 16, 49.6% vs. 38.6%, p < 0.0001) than those admitted to the mixed ICU. Need for immediate operative intervention was similar (18.0% vs. 17.6%, p = 0.788). Overall complications were significantly higher in trauma patients admitted to the mixed ICU (27.5% vs. 17.0%, p < 0.0001), as well as FTR (3.7% vs. 1.8%, p < 0.0001). Trauma patients admitted to a dedicated TICU had significantly lower chance of developing a postinjury complication (adjusted odds ratio [AOR], 0.5; p < 0.0001), FTR (AOR, 0.3; p < 0.0001), and overall mortality (AOR, 0.4; p < 0.0001).ConclusionAdmission of critically ill trauma patients to a TICU staffed by a surgical intensivist is associated with a lower complication rate and FTR. Factors such as trauma nursing experience, education, and unit management structure should be further explored to elucidate the observed improved outcomes.Level Of EvidencePrognostic study, level III.

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