Severely injured patients in the intensive care unit: a critical analysis of outcome and unexpected deaths identified by the TRISS methodology.
An analysis of the factors related to the morbidity and mortality of 64 patients sustaining abdominal trauma requiring intensive care during the postoperative period, and an evaluation of the unexpected deaths based on trauma indices was carried out to identify factors that could have contributed to the observed outcome. Head and chest injuries occurred in approximately 40% of all patients. Pneumonia was the most common complication. ISS (p = 0.03), but not TS was statistically significant as predictor of outcome. Probability of survival (TRISS) was 62.4 +/- 4.2%, while observed overall survival rate was 54.7%. Multivariate analysis identified age greater than 45 years (p = 0.02; RR = 2.5) and ISS greater than 20 (p = 0.03; RR = 4.0) as the most predictive factors for systemic complications. Mortality was directly influenced by age greater than 45 years (p = 0.05; RR = 2.4) and by the presence of a systemic complication (p = 0.003; RR = 5.5). Eleven patients were classified as "unexpected death"; 5 were considered preventable, 3 non preventable, 1 potentially preventable, and 2 cases had incomplete data and could not be classified. Changes in the care of the severely injured due to a review of complications and deaths may ultimately lead to a reduction in errors and a better quality of care.