From the Research
In Australian blunt trauma care, a prolonged ICU stay is generally defined as a length of stay exceeding 7 days. This definition is based on the most recent and highest quality study available, which investigated the ICU length of stay and factors associated with longer stay of major trauma patients with multiple rib fractures 1. The study found that the median ICU length of stay was 4 days, and patients who stayed longer than 7 days in ICU had higher Injury Severity Score (ISS), higher APACHE-II score, greater number of rib fractures, higher rate of lung contusions, and required more respiratory support of any type.
The 7-day threshold is significant because it typically represents the point at which patients transition from acute stabilization to more complex recovery phases, often involving complications such as ventilator-associated pneumonia, catheter-related infections, or multiorgan dysfunction. Patients requiring ICU care beyond this timeframe frequently need comprehensive multidisciplinary management including specialized respiratory support, nutritional interventions, early rehabilitation, and prevention of secondary complications.
Key factors associated with prolonged ICU stay in blunt trauma patients include:
- Higher ISS
- Higher APACHE-II score
- Greater number of rib fractures
- Higher rate of lung contusions
- Presence of flail chest
- Need for respiratory support
This definition helps trauma centers allocate resources appropriately, plan for extended care needs, and identify patients who may benefit from early intervention strategies to prevent complications associated with prolonged critical care. It also serves as a useful metric for quality improvement initiatives and benchmarking across different trauma centers in Australia.