It is important that trauma victims be admitted to the proper care area so that clinical needs can be accommodated. Patients with high-grade single system injuries (liver trauma, TBI, spinal cord injury) warrant ICU admission as well as patients in shock. Two populations in particular require special attention because their need for ICU-level care may not be immediately apparent: geriatric trauma patients and patients whose thoracic trauma may become progressively more symptomatic as pain or pulmonary contusions evolve. To address these 2 special populations, UK's trauma center will empoly a 'Geriatric ICU Admission Guideline' and the Rib Injury Guideline (RIG). See below:
Geriatric ICU Admission Guideline
Patients greater than 65 years of age admitted with the following should be strongly considered for ICU admission:
Physiologic compromise
Relative hypotension / Shock
SBP ≤110mmHg
Tachycardia
≥ 120 beats/min
Tachypnea/dyspnea
Acidosis
BD > 6
LA > 2.5
Increased O2 requirement
Agitation / delirium
High-risk mechanism of injury
Rollover
Ejection
High speed MVC
Significant injury burden
Chest trauma
With respiratory compromise
With 6 or more rib fractures
COPD
New TBI with impaired GCS or anticoagulant
Confirmed or suspected hemorrhage of any source
New SCI
Significant comorbidity
Uncertain cardiovascular status
Chronic cardiovascular compromise
Chronic renal disease with acute insult
High risk for or confirmed ETOH withdrawal
High likelihood of urgent procedural intervention
References:
Thurston M, Robinson T, Pandhiri T, McGhee K, Bryant C, Drahos A, Jenkins P, Levin J, Rodriguez R. Geriatric Trauma Intensive Care Unit Admission Guideline is Associated With Reduction in Unplanned Intensive Care Unit Admissions. J Surg Res. 2024 Sep 2;302:790-797. https://pubmed.ncbi.nlm.nih.gov/39226703/
Warriner, Z., & Bernard, A. C. (2020). Geriatric Trauma: Triage Guidelines. Current Trauma Reports, 6(4), 125-132. https://scholars.uky.edu/en/publications/geriatric-trauma-triage-guidelines
Geriatric Trauma (Update) East Practice Management Guidelines. https://www.east.org/education-resources/practice-management-guidelines/archived/geriatric-trauma-update
ACS TQIP Best Practice Guidelines. Geriatric Trauma Management. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf
