Hospital post-intensive management of major trauma: a pilot study in Internal Medicine

BACKGROUND Major trauma is the fourth cause of death in Western countries, and the first one in patients aged 35 years or younger. In-hospital post-intensive care represents a crucial step in the comprehensive medical assistance for these patients, but no data is available. AIM OF THE STUDY To evaluate an hospital post-intensive clinical pathway for patients with major trauma discharged from Intensive Care Unit (ICU). PATIENTS AND METHODS We designed a clinical pathway project for patients with major trauma discharged from an ICU at Careggi Hospital, in Florence. Patients were admitted in two Internal Medical wards of the same hospital. Nurses and physicians were trained to the management of devices and essential critical problems. We analysed characteristics of patients, APACHE score, devices, clinical and biochemical parameters. We determined medical complicances, ICU readmissions and hospital mortality. After a three months follow-up we evaluated hospital readmission, mortality and residual disability. RESULTS AND DISCUSSION We studied 92 patients (mean age 41 ± 20 years; 70 male) with major trauma discharged from ICU (82.6% of patients underwent invasive mechanic ventilation). On admission, tracheotomy tube was present in 21 patients (22.8%). During internal wards stay, tracheotomy tube was removed in 16 patients. Medical complicances were identified and treated in more than 80% of patients. Four patients (4.3%) were readmitted to ICU, one patient (1.1%) died. Mean internal medical ward stay was 13 ± 9.6 days. After three months follow-up: three patients (3.2%) died; the rate of planned hospital readmission for orthopedic or surgery interventions was 14.7%; 70% of patients did not have any disability. CONCLUSIONS Patients with major trauma discharged from ICU often have medical complications and are managed by the use of multiple devices. Results of our pilot study suggest that a post-intensive clinical pathway in internal wards for patients with major trauma is feasible and could reduce ICU readmissions and hospital mortality.