Acute and Critical Care

Original Articles

Trauma
Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea: Yongwoong Lee, Byung Hee Kang; Acute Crit Care. 2024;39(4):583-592. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00584

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Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems.

Citations

Citations to this article as recorded by

Unplanned intensive care unit admissions in trauma patients: A critical appraisal
Amlan Swain, Deb Sanjay Nag, Jayanta Kumar Laik, Seelora Sahu, Mrunalkant Panchal, Shivani Srirala
World Journal of Critical Care Medicine.2025;[Epub] CrossRef
Circulation-first trauma resuscitation and mortality: A 9-year single-center retrospective study
Donghwan Choi, Kyoungwon Jung
Journal of Trauma and Acute Care Surgery.2025;[Epub] CrossRef

Pulmonary
Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea: Yong Hoon Lee, Jaehee Lee, Byunghyuk Yu, Won Kee Lee, Sun Ha Choi, Ji Eun Park, Hyewon Seo, Seung Soo Yoo, Shin Yup Lee, Seung-Ick Cha, Chang Ho Kim, Jae Yong Park; Acute Crit Care. 2023;38(4):442-451. Published online November 21, 2023; DOI: https://doi.org/10.4266/acc.2023.00682

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Abstract PDF Supplementary Material

Background
Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking.
Methods
We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed.
Results
The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival.
Conclusions
Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

Citations

Citations to this article as recorded by

The COVID-19 pandemic: an underlying factor for increased Stenotrophomonas maltophilia infections—A literature review and case study analysis
Arianna Pompilio, Giovanni Di Bonaventura
Frontiers in Microbiology.2026;[Epub] CrossRef
Management and outcomes of Stenotrophomonas maltophilia recovered from deep-site clinical specimens: a bicentric retrospective cohort study
Anastasia Saade, Benoît Pilmis, Hervé Jacquier, Matthieu Lafaurie, Pierre Sellier, David Michonneau, David Lebeaux, Béatrice Berçot, Anne-Lise Munier
Journal of Antimicrobial Chemotherapy.2026;[Epub] CrossRef
How do I manage a patient with Stenotrophomonas maltophilia infection?
Roberta Monardo, Maria F. Mojica, Marco Ripa, Samuel L. Aitken, Robert A. Bonomo, David van Duin
Clinical Microbiology and Infection.2025; 31(8): 1291. CrossRef
Antimicrobial Resistance of Non-Fermenting Gram-Negative Bacilli in a Multidisciplinary Hospital in Romania
Miruna-Maria Apetroaei, Mihaela Cristina Negulescu, Sorina Hîncu, Adriana Tăerel, Manuela Ghica, Andreea Letiția Arsene, Denisa Ioana Udeanu
Biomedicines.2025; 13(9): 2255. CrossRef
Stenotrophomonas maltophilia Outbreak in an ICU: Investigation of Possible Routes of Transmission and Implementation of Infection Control Measures
Maria Luisa Cristina, Marina Sartini, Gianluca Ottria, Elisa Schinca, Giulia Adriano, Leonello Innocenti, Marco Lattuada, Stefania Tigano, David Usiglio, Filippo Del Puente
Pathogens.2024; 13(5): 369. CrossRef
Establishment and evaluation of a rapid method for the detection of bacterial pneumonia in hospitalized patients via multiplex PCR–capillary electrophoresis (MPCE)
Jie Wang, Pei Zhao, Mengchuan Zhao, Duoxiao Zhang, Shan Chen, Ying Liu, Yuan Gao, Yanqing Tie, Zhishan Feng, Siu-Kei Chow
Microbiology Spectrum.2024;[Epub] CrossRef
A systematic review of factors associated with poor prognosis despite appropriate antibiotics usage for pneumonia
Akihiko Goto, Kentaro Ishikawa, Kosaku Komiya
Respiratory Investigation.2024; 62(6): 1215. CrossRef

Trauma
Association of Glasgow coma scale and endotracheal intubation in predicting mortality among patients admitted to the intensive care unit: Nader Markazi Moghaddam, Mohammad Fathi, Sanaz Zargar Balaye Jame, Mohammad Darvishi, Morteza Mortazavi; Acute Crit Care. 2023;38(1):113-121. Published online February 22, 2023; DOI: https://doi.org/10.4266/acc.2022.00927

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Abstract PDF

Background
We assessed predictors of mortality in the intensive care unit (ICU) and investigated if Glasgow coma scale (GCS) is associated with mortality in patients undergoing endotracheal intubation (EI).
Methods
From February 2020, we performed a 1-year study on 2,055 adult patients admitted to the ICU of two teaching hospitals. The outcome was mortality during ICU stay and the predictors were patients’ demographic, clinical, and laboratory features.
Results
EI was associated with a decreased risk for mortality compared with similar patients (adjusted odds ratio [AOR], 0.32; P=0.030). This shows that EI had been performed correctly with proper indications. Increasing age (AOR, 1.04; P<0.001) or blood pressure (AOR, 1.01; P<0.001), respiratory problems (AOR, 3.24; P<0.001), nosocomial infection (AOR, 1.64; P=0.014), diabetes (AOR, 5.69; P<0.001), history of myocardial infarction (AOR, 2.52; P<0.001), chronic obstructive pulmonary disease (AOR, 3.93; P<0.001), immunosuppression (AOR, 3.15; P<0.001), and the use of anesthetics/sedatives/hypnotics for reasons other than EI (AOR, 4.60; P<0.001) were directly; and GCS (AOR, 0.84; P<0.001) was inversely related to mortality. In patients with trauma surgeries (AOR, 0.62; P=0.014) or other surgical categories (AOR, 0.61; P=0.024) undergoing EI, GCS had an inverse relation with mortality (accuracy=82.6%, area under the receiver operator characteristic curve=0.81).
Conclusions
A variety of features affected the risk for mortality in patients admitted to the ICU. Considering GCS score for EI had the potential of affecting prognosis in subgroups of patients such as those with trauma surgeries or other surgical categories.

Citations

Citations to this article as recorded by

Early heart-rate trajectory phenotypes predict short-term mortality in critically ill patients: a dynamic time-warping cluster analysis
Toko Hirano, Masashi Ishikawa, Takuya Nishino, Toru Takiguchi, Yutaka Igarashi, Shoji Yokobori
Journal of Clinical Monitoring and Computing.2026;[Epub] CrossRef
The Application of Scoring Systems in Pediatric Intensive Care Unit for Onco-Hematological Patients Who Have Not Undergone Stem Cell Transplantation: A Cross-Sectional Study
Shereen Abdelmonem Mohamed Mohamed, Hanaa Ibrahim Abdel Fattah Rady, Eman Hany Ahmed Elsebaie, Rana Saber Bastawy Mahmoud
Indian Journal of Medical and Paediatric Oncology.2026;[Epub] CrossRef
Development and pilot testing of the AMPS model for predicting ICU mortality in low and middle income countries
Finot Debebe, Abate Yeshidinber Weldetsadik, Adam Laytin, Alberto Goffi, Getaw Hassen, Menbeu Sultan, Lemlem Beza, Merahi Kefyalew Merahi, Ayalew Zewdie, Yared Firissa, Woldesenbet Waganew, Emnet Tesfaye Shimber, Neill Adhikari
Scientific Reports.2026;[Epub] CrossRef
Airway management and functional outcomes in intubated patients with ischemic stroke
Jae Wook Jung, Ilmo Kang, Jin Park, Sang-Beom Jeon
Scientific Reports.2025;[Epub] CrossRef
The Glasgow Coma Scale: an international standard for education and practice with adults
Neal Cook, Ruth Trout, Catheryne Waterhouse, Mary Braine, Chris Barrett, Paul Brennan, Graham Teasdale, Ole Abildgaard Hansen, Valeria Caponnetto, Pedro Raúl Castellano Santana, Hilalnur Küçükakgün, Claire Lynch, Andrea Shepherd, Zeliha Tulek, Zoé Wahl
British Journal of Neuroscience Nursing.2025; 21(Sup1c): S1. CrossRef
Using nursing data for machine learning-based prediction modeling in intensive care units: A scoping review
Yesol Kim, Mihui Kim, Yeonju Kim, Mona Choi
International Journal of Nursing Studies.2025; 169: 105133. CrossRef

Trauma
Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience: Seungwoo Chung, Donghwan Choi, Jayun Cho, Yo Huh, Jonghwan Moon, Junsik Kwon, Kyoungwon Jung, John-Cook Jong Lee, Byung Hee Kang; Acute Crit Care. 2018;33(3):130-134. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00122

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Abstract PDF

Background
We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition.
Methods
Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) <15, length of stay <8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3.
Results
A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P<0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P<0.001). Multivariate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system.
Conclusions
Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively.

Citations

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Lessons Learned From Large Animal Models of Trauma-Induced AKI
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Seminars in Nephrology.2026; 46(1): 151670. CrossRef
Sex differences in the time trends of sepsis biomarkers following polytrauma
Cédric Niggli, Philipp Vetter, Jan Hambrecht, Hans-Christoph Pape, Ladislav Mica
Scientific Reports.2025;[Epub] CrossRef
Identifying early predictive and diagnostic biomarkers and exploring metabolic pathways for sepsis after trauma based on an untargeted metabolomics approach
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Scientific Reports.2025;[Epub] CrossRef
ASSESSMENT OF EARLY INDICATORS FOR SEPSIS DEVELOPMENT IN MULTIPLE TRAUMA PATIENTS—THE SEPSIS AS TRAUMA OUTCOME PREDICTION (STOP) SCORE
Nils Becker, Jasmin Maria Bülow, Niklas Franz, Ingo Marzi, Florian Gebhard, Akiko Eguchi, Helen Rinderknecht, Borna Relja
Shock.2025; 64(2): 187. CrossRef
Impact of trauma level designation on mortality in trauma patients with sepsis: an observational study across US trauma centers
Ralphe Bou Chebl, Razan Diab, Reem Siblini, Rana Bachir, Mazen El Sayed
Frontiers in Medicine.2025;[Epub] CrossRef
Antecedent traumatic injuries independently predict higher 90-day mortality for patients admitted to the ICU with surgical sepsis
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A biomarker panel of C-reactive protein, procalcitonin and serum amyloid A is a predictor of sepsis in severe trauma patients
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Cédric Niggli, Philipp Vetter, Jan Hambrecht, Hans-Christoph Pape, Ladislav Mica
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Defining Posttraumatic Sepsis for Population-Level Research
Katherine Stern, Qian Qiu, Michael Weykamp, Grant O’Keefe, Scott C. Brakenridge
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Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU®
Felix M. Bläsius, Markus Laubach, Hagen Andruszkow, Philipp Lichte, Hans-Christoph Pape, Rolf Lefering, Klemens Horst, Frank Hildebrand
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Infectious Diseases-Related Emergency Department Visits Among Non-Elderly Adults with Intellectual and Developmental Disabilities in the United States: Results from the National Emergency Department Sample, 2016
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Australian Critical Care.2021; 34(3): 269. CrossRef
Accuracy of Procalcitonin Levels for Diagnosis of Culture-Positive Sepsis in Critically Ill Trauma Patients: A Retrospective Analysis
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Case Report

Atrial Fibrillation Developed after Induction of General Anesthesia in an Elderly Patient: A case report: Seok Ho Han, Jin Woo Choi; Korean J Crit Care Med. 1998;13(2):261-261.

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Abstract PDF: It is known that the incidence of arrhythmia related to anesthesia and operation is significantly higher in thoracic surgery such as cardiac, lung operation than any other operation, and atrial fibrillation is the most common arrhythmia among these arrhythmias. Besides operative sites, age and underlying cardiac problem such as hypertension, cardiomegaly can be important risk factors for intra, post-operative atrial fibrillation in non-thoracic surgery. Through many investigations, we can find that age is the most important because age related anatomical, physiological cardiac changes make elderly patients more susceptible to development of atrial fibrillation. In this case, we report atrial fibrillation that occurred after induction of general anesthesia in an elderly patient undergoing open reduction of upper arm fracture.

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