Zahra Shayan; Shahram Paydar; Fatemeh Maghsoudi; Ali Taheri Akerdi; Leila Shayan
Volume 23, Issue 11 , 2021
Abstract
Background: Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization.
Objectives: This study aimed to identify ...
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Background: Trauma is considered an important issue in most countries. Identification of the factors affecting the length of stay (LOS) in the intensive care unit (ICU) plays a crucial role in controlling the costs and complications of prolonged hospitalization.
Objectives: This study aimed to identify the factors affecting the LOS of trauma patients in the ICU using stepwise and new penalized variable selection methods in count data regression.
Methods: The patients information was evaluated in Emtiaz Hospital and Shahid Rajaee trauma center in Shiraz from March 2016 to September 2017. Count regression model was used to determine the factors affecting the LOS of patients in the ICU using penalized variable selection including, Enet, Snet, and Mnet.
Results: The mean age of the patients (n=382) was obtained at 36.7±16.7 years, and the majority (88.4%) of the patients were male. The mean LOS in the ICU was determined at 6.2±6.6 days. Mnet with a negative binomial distribution outperformed the other penalized variable selection methods. A Glasgow Coma Scale (GCS) of less than 9 (IRR=1.7), blunt brain trauma (IRR=1.8), chest trauma (IRR=2.2), and oxygen saturation of less than 90 (IRR=1.2) increased the LOS of trauma patients in the ICU.
Conclusion: Penalized variable selection methods effectively ignore or control the existing correlations between predictors. Amongst the penalized models, Mnet provided more acceptable results with smaller Akaike information criterion and fewer predictors. According to this penalty, the most important factors affecting the length of stay were chest trauma, blunt brain trauma, GCS, and oxygen saturation rate. Most clinical studies on trauma have also shown the importance of these factors.
Mahnaz Yadollahi; Mehrdad Anvar; Haleh Ghaem; Shahram Bolandparvaz; Shahram Paydar; Fateme Izianloo
Volume 19, Issue 1 , January 2017, , Pages 1-9
Abstract
Background: Since injury-related mortality is preventable, identifying factors that inversely affect trauma outcome are important initial steps towards reducing injury burden.Objectives: This study aims to determine independent risk factors of early/late in-hospital mortality among adult trauma victims ...
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Background: Since injury-related mortality is preventable, identifying factors that inversely affect trauma outcome are important initial steps towards reducing injury burden.Objectives: This study aims to determine independent risk factors of early/late in-hospital mortality among adult trauma victims with equal injury characteristics and severity at Shahid Rajaee (Emtiaz) Hospital during 2013 and 2014.Patients and Methods: A cross-sectional study of adult trauma patients (age≥ 15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from three hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, injury descriptions, outcomes of hospitalization, and development of nosocomial infections were recorded. Injury severity score was calculated by cross walking from international classification of diseases (ICD-10) injury diagnosis codes to abbreviated injury scale (AIS-98) severity codes. Two multiple logistic regression models were employed to reflect the partial effect of each covariate on early (within 48 hours) and late (beyond 48 hours) deaths.Results: There were 47,295 hospitalized patients (male/female ratio: 2.7:1.0) with a median age of 30 years (interquartile range 23 - 44 years). A crude mortality rate of 1% (454 cases) was observed and 52% of deaths occurred within 48 hours of hospital arrival. One percent developed a nosocomial infection in the course of admission. After adjusting for covariates, sustaining a thoracic injury (OR 8.5, 95% CI [4.7 - 15.2]), ISS over 16 (OR 6.4, 95% CI [3.6 - 11.4]) and age over 65 years (OR 5.1, 95% CI [3.0 - 8.8]) were the most important independent risk factors of early trauma death. Presence of a hospital-acquired infection (OR 12.7, 95% CI [8.9 - 18.1]), age over 65 years (OR 7.4 95% CI [4.5 - 12.1]), and ISS of more than 16 (OR 14.6, 95% CI [6.2 - 34.3]) were independent predictors of late death.Conclusions: Age, injury severity, injured body region, and hospital-acquired infections are important determinants of trauma outcome in our center. Timely recognition of factors affecting trauma mortality is crucial for monitoring changes of trauma quality of care. Our findings suggest the need to allocate resources for trauma prevention along with a potential focus on reducing inhospital complications.
