Influence of specialization from intensive care physicians on outcome in multiply injured patients – a matched-pair analysis at a level I trauma center

Abstract The treatment of severely injured trauma patients is a significant challenge for physicians and requires a qualified interprofessional team skilled in critical care medicine. Between 2005 and 2022 all multiple trauma patients admitted to our level I trauma center (age \(>\)16 and injury severity score \(\geq\) 16) were enrolled in a retrospective single-center cohort study, using a matched pair analysis to determine how the physicians specialization influences the outcome of these patients. 1.015 patients were included, of which 920 patients (90.6% ) were allocated to the T-ICU and 95 patients (9.4%) to the A-ICU. While no differences in age and gender distribution could be found between the groups. Patients admitted to the A-ICU tended to be in worse medical conditions before trauma (ASA 1.6 ± 0.7 vs. 1.4 ± 0.7, p=0.044). However patients admitted to T-ICU tended to have more severe extremity and pelvic injuries according to the AIS (2.3 ± 1.4 vs. 1.8 ± 1.4, p = 0.006), and showed more often shock (18.9 % vs. 10.5 %, p = 0,043), while also receiving an increased amount of PRBC (10.4 ± 16.3 vs. 7.5 ± 11.3, p = 0.025) and TC (1.2 ± 3.4 vs. 0.7 ± 1.4, p = 0.008). After matching 52 patients remained, equally distributed (n=26) to each study group. No differences were found regarding age, gender distribution, pre-existing medical conditions, injury pattern and injury severity. Treatment parameters regarding duration of mechanical ventilation, intensive care and in-hospital stay were comparable in matched T-ICU and A-ICU group. Transfusion requirements within the first 48 hours and throughout the entire hospital stay were also not different. The mortality in the matched overall population was 13.5 % (n=7) showing no statistically significant difference. Also, no differences were found concerning the Glasgow Outcome Scale (GOS). The aim of this study was to analyze the influence of the intensive care medical specialty on the treatment and the resulting outcome of severely injured patients.However, the study faces limitations due to its small sample size, retrospective and monocentric design, and extended study duration. Consequently, further research is essential to provide more robust data.