Determinants of long-term physical and mental health outcomes after intensive care admission for trauma survivors

Juan P Herrera-Escobar; Taylor Lamarre; Jordan Rosen; Saba Ilkhani; Ashley N Haynes; Kaman Hau; Kendall Jenkins; Jack Ruske; Joyce Y Wang; Jessica Serventi-Gleeson; Sabrina E Sanchez; Haytham Ma Kaafarani; George Velmahos; Ali Salim; Nomi C Levy-Carrick; Geoffrey A Anderson

doi:10.1016/j.amjsurg.2024.02.013

Determinants of long-term physical and mental health outcomes after intensive care admission for trauma survivors

Am J Surg. 2024 Feb 14:S0002-9610(24)00100-4. doi: 10.1016/j.amjsurg.2024.02.013. Online ahead of print.

Authors

Juan P Herrera-Escobar¹, Taylor Lamarre², Jordan Rosen³, Saba Ilkhani⁴, Ashley N Haynes⁵, Kaman Hau⁶, Kendall Jenkins⁷, Jack Ruske⁸, Joyce Y Wang⁹, Jessica Serventi-Gleeson¹⁰, Sabrina E Sanchez¹¹, Haytham Ma Kaafarani¹², George Velmahos¹³, Ali Salim¹⁴, Nomi C Levy-Carrick¹⁵, Geoffrey A Anderson¹⁶

Affiliations

¹ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jherreraescobar@bwh.harvard.edu.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: taylor.lamarre20@gmail.com.
³ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jrosen2@bwh.harvard.edu.
⁴ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: silkhani@bwh.harvard.edu.
⁵ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ashleyhaynes@gmail.com.
⁶ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: kmanhau@gmail.com.
⁷ Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Electronic address: kmj7am@bu.edu.
⁸ Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Electronic address: jruske@bu.edu.
⁹ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: wyjoyce@uw.edu.
¹⁰ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jserventigleeson@gmail.com.
¹¹ Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. Electronic address: sabrina.sanchez@bmc.org.
¹² Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: HKAAFARANI@mgh.harvard.edu.
¹³ Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: GVELMAHOS@mgh.harvard.edu.
¹⁴ Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: asalim1@bwh.harvard.edu.
¹⁵ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: nlevy-carrick@bwh.harvard.edu.
¹⁶ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: GANDERSON@BWH.HARVARD.EDU.

PMID: 38413351
DOI: 10.1016/j.amjsurg.2024.02.013

Abstract

Introduction: Collectively, studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. We sought to identify determinants of post-intensive care physical and mental health outcomes 6-12 months after injury.

Methods: Adult trauma patients [ISS ≥9] admitted to one of three Level-1 trauma centers were interviewed 6-12 months post-injury to evaluate patient-reported outcomes. Patients requiring ICU admission ≥ 3 days ("ICU patients") were compared with those who did not require ICU admission ("non-ICU patients"). Multivariable regression models were built to identify factors associated with poor outcomes among ICU survivors.

Results: 2407 patients were followed [598 (25%) ICU and 1809 (75%) non-ICU patients]. Among ICU patients, 506 (85%) reported physical or mental health symptoms. Of them, 265 (52%) had physical symptoms only, 15 (3%) had mental symptoms only, and 226 (45%) had both physical and mental symptoms. In adjusted analyses, compared to non-ICU patients, ICU patients were more likely to have new limitations for ADLs (OR = 1.57; 95% CI = 1.21, 2.03), and worse SF-12 mental (mean Δ = -1.43; 95% CI = -2.79, -0.09) and physical scores (mean Δ = -2.61; 95% CI = -3.93, -1.28). Age, female sex, Black race, lower education level, polytrauma, ventilator use, history of psychiatric illness, and delirium during ICU stay were associated with poor outcomes in the ICU-admitted group.

Conclusions: Physical impairment and mental health symptoms following ICU stay are highly prevalent among injury survivors. Modifiable ICU-specific factors such as early liberation from ventilator support and prevention of delirium are potential targets for intervention.

Keywords: ICU; Longterm outcomes; Patient-report outcomes; Social determinants of health; Traumatic injury.

Published by Elsevier Inc.