Yonsei Med J.  2013 Mar;54(2):432-436. 10.3349/ymj.2013.54.2.432.

Feasibility and Early Outcomes of Intensivist-Led Critical Care after Major Trauma in the Korean ICU

• Kim KD
• Lee JW
• Park HK

• KMID: 1503907
• DOI: http://doi.org/10.3349/ymj.2013.54.2.432

Abstract

PURPOSE
Substantial evidence supports the benefits of an intensivist model of critical care delivery. However, currently, this mode of critical care delivery has not been widely adopted in Korea. We hypothesized that intensivist-led critical care is feasible and would improve ICU mortality after major trauma.
MATERIALS AND METHODS
A trauma registry from May 2009 to April 2011 was reviewed retrospectively. We evaluated the relationship between modes of ICU care (open vs. intensivist) and in-hospital mortality following severe injury [Injury Severity Score (ISS) >15]. An intensivist-model was defined as ICU care delivered by a board-certified physician who had no other clinical responsibilities outside the ICU and who is primarily available to the critically ill or injured patients. ISS and Revised Trauma Score were used as measure of injury severity. The Trauma and Injury Severity Score methodology was used to calculate each individual patient's probability of survival.
RESULTS
Of the 251 patients, 57 patients were treated by an intensivist [intensivist group (IG)] while 194 patients were not [non-intensivist group (NIG)]. The ISS of IG was significantly higher than that for NIG (26.5 vs. 22.3, p=0.023). The hospital mortality rate for IG was significantly lower than that for NIG (15.8% and 27.8%, p<0.001).
CONCLUSION
The intensivist model of critical care is feasible, and there is room for improvement in the care of major trauma patients. Although trauma systems take time to mature, future studies are needed to evaluate the best model of critical care delivery for severely injured patients in Korea.

Keyword

Intensive care; trauma system; outcome; injury; TRISS

MeSH Terms

Adult
Aged
Critical Care/*methods
Female
Hospital Mortality
Humans
Intensive Care/*methods
*Intensive Care Units
Male
Middle Aged
Models, Theoretical
Postoperative Care/methods
*Specialization
Trauma Centers